Provider Demographics
NPI:1952325789
Name:NAIR, GOPAL K (MD)
Entity Type:Individual
Prefix:
First Name:GOPAL
Middle Name:K
Last Name:NAIR
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Gender:M
Credentials:MD
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Mailing Address - Street 1:12101 WOODCREST EXECUTIVE DR
Mailing Address - Street 2:SUITE 210
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-5047
Mailing Address - Country:US
Mailing Address - Phone:314-317-0600
Mailing Address - Fax:314-317-0606
Practice Address - Street 1:12101 WOODCREST EXECUTIVE DR
Practice Address - Street 2:SUITE 210
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-5047
Practice Address - Country:US
Practice Address - Phone:314-317-0600
Practice Address - Fax:314-317-0606
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2014-06-18
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Provider Licenses
StateLicense IDTaxonomies
MOR8341207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1952325789Medicaid
MO1952325789Medicaid
MO139000112Medicare PIN