Provider Demographics
NPI:1932115631
Name:GOWDA, RANJIT B (MD)
Entity Type:Individual
Prefix:
First Name:RANJIT
Middle Name:B
Last Name:GOWDA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2620 SE MARICAMP RD
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-5582
Mailing Address - Country:US
Mailing Address - Phone:352-690-7777
Mailing Address - Fax:352-690-7788
Practice Address - Street 1:2620 SE MARICAMP RD
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-5582
Practice Address - Country:US
Practice Address - Phone:352-690-7777
Practice Address - Fax:352-690-7788
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2015-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-094656208000000X, 208100000X, 2081P2900X
FLME 974272081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME 97427OtherFLORIDA LICENSE
ILG43568Medicare UPIN
FLME 97427OtherFLORIDA LICENSE