Provider Demographics
NPI:1639513286
Name:RAMAMURTHI, DEEPA (MD)
Entity Type:Individual
Prefix:
First Name:DEEPA
Middle Name:
Last Name:RAMAMURTHI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 112610
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32611-2700
Mailing Address - Country:US
Mailing Address - Phone:352-294-5550
Mailing Address - Fax:352-265-7228
Practice Address - Street 1:6431 FANNIN ST
Practice Address - Street 2:SUITE 308 JJL
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-1501
Practice Address - Country:US
Practice Address - Phone:713-500-7610
Practice Address - Fax:713-500-7619
Is Sole Proprietor?:No
Enumeration Date:2013-04-25
Last Update Date:2018-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLME137954207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL101083000Medicaid