Provider Demographics
NPI:1336763283
Name:UPPAL, PAVEN (DO)
Entity Type:Individual
Prefix:DR
First Name:PAVEN
Middle Name:
Last Name:UPPAL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:DR
Other - First Name:PAVEN
Other - Middle Name:PREET
Other - Last Name:UPPAL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:11373 CORTEZ BLVD STE 408
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34613-5406
Mailing Address - Country:US
Mailing Address - Phone:352-597-3088
Mailing Address - Fax:
Practice Address - Street 1:11373 CORTEZ BLVD STE 408
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34613-5406
Practice Address - Country:US
Practice Address - Phone:352-597-3088
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-05
Last Update Date:2020-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program