MEDICARE: DR. ANAND S GUPTA MD

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	208600000X	Surgery Physician	ME067766	FL
2	208600000X	Surgery Physician	ME67766	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1518946888	OTHER	FL	NATIONAL PROVIDER IDENTIFIER NPI
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1518946888
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANAND S GUPTA MD

Provider Business Mailing Address
First Line	:	2535 UNIVERSITY BLVD W
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32217-2003
Country	:	US
Telephone Number	:	904-874-8282
Fax Number	:	904-367-0211

Provider Business Practice Location Address
First Line	:	2535 UNIVERSITY BLVD W
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32217-2003
Country	:	US
Telephone Number	:	904-367-8686
Fax Number	:	904-367-0211

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

Provider Enumeration Date	:	01/13/2006
Last Update Date	:	07/10/2020

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