Provider Demographics
NPI:1649295288
Name:GOPAL, USHA M (MD)
Entity type:Individual
Prefix:MRS
First Name:USHA
Middle Name:M
Last Name:GOPAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:633 E RAY RD # 128
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85296-4200
Mailing Address - Country:US
Mailing Address - Phone:480-497-3946
Mailing Address - Fax:480-497-3947
Practice Address - Street 1:633 E RAY RD # 128
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85296-4200
Practice Address - Country:US
Practice Address - Phone:480-497-3946
Practice Address - Fax:480-497-3947
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2011-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ33590207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ941858Medicaid
AZI34013Medicare UPIN