Healthcare Provider Details

I. General information

NPI: 1396005153
Provider Name (Legal Business Name): SUBHASH C. GUPTA, MD, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2012
Last Update Date: 05/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 E SAMPLE RD SUITE 105
POMPANO BEACH FL
33064
US

IV. Provider business mailing address

601 E. SAMPLE ROAD SUITE 105
POMPANO BEACH FL
33064
US

V. Phone/Fax

Practice location:
  • Phone: 954-943-1133
  • Fax: 954-783-6845
Mailing address:
  • Phone: 954-344-2522
  • Fax: 954-344-9189

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberME43566
License Number StateFL

VIII. Authorized Official

Name: SUBHASH C GUPTA
Title or Position: DOCTOR/OWNER
Credential: MD
Phone: 954-739-9000