Provider Demographics
NPI:1780187716
Name:GOPAL, PUNAM (PA-C)
Entity Type:Individual
Prefix:
First Name:PUNAM
Middle Name:
Last Name:GOPAL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3507 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33407-4841
Mailing Address - Country:US
Mailing Address - Phone:561-842-8848
Mailing Address - Fax:
Practice Address - Street 1:3507 BROADWAY
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33407-4841
Practice Address - Country:US
Practice Address - Phone:561-842-8848
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-15
Last Update Date:2018-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant