MEDICARE: DR. RAJAT GUPTA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084N0400X	Neurology Physician	K0794	TX
2	2084P2900X	Pain Medicine (Psychiatry & Neurology) Physician	K0794	TX
3	208VP0000X	Pain Medicine Physician	K0794	TX
4	208VP0014X	Interventional Pain Medicine Physician	K0794	TX

General Provider Information

NPI Number	:	1225031552
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RAJAT GUPTA M.D.

Provider Business Mailing Address
First Line	:	4407 BEE CAVE RD
Second Line	:	SUITE 211
City	:	AUSTIN
State	:	TX
Zip	:	78746-6405
Country	:	US
Telephone Number	:	512-330-0961
Fax Number	:	512-330-0962

Provider Business Practice Location Address
First Line	:	4407 BEE CAVE RD
Second Line	:	SUITE 211
City	:	AUSTIN
State	:	TX
Zip	:	78746-6405
Country	:	US
Telephone Number	:	512-330-0961
Fax Number	:	512-330-0962

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	08/16/2007

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