Provider Demographics
NPI:1932104726
Name:GOPFERT, ROSE GUGU (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:ROSE
Middle Name:GUGU
Last Name:GOPFERT
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7235 14TH ST N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33702-5735
Mailing Address - Country:US
Mailing Address - Phone:727-743-5647
Mailing Address - Fax:727-522-2008
Practice Address - Street 1:7235 14TH ST N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33702-5735
Practice Address - Country:US
Practice Address - Phone:727-743-5647
Practice Address - Fax:727-522-2008
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT4287174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ056UMedicare UPIN
FLK4810Medicare ID - Type Unspecified