Healthcare Provider Details

I. General information

NPI: 1881652956
Provider Name (Legal Business Name): SUBHASH C GUPTA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2006
Last Update Date: 05/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 E SAMPLE ROAD 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:
Title or Position:
Credential:
Phone: