Healthcare Provider Details

I. General information

NPI: 1497850523
Provider Name (Legal Business Name): RONALD STUART GUP M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 04/14/2021
Certification Date: 04/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4060 SHERIDAN ST SUITE B
HOLLYWOOD FL
33021-3559
US

IV. Provider business mailing address

4060 SHERIDAN ST STE A
HOLLYWOOD FL
33021-3559
US

V. Phone/Fax

Practice location:
  • Phone: 954-966-9001
  • Fax:
Mailing address:
  • Phone: 195-496-6900
  • Fax: 954-985-0456

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number44479
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: