Healthcare Provider Details

I. General information

NPI: 1598887754
Provider Name (Legal Business Name): BHUPENDRA KUMAR GUPTA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2007
Last Update Date: 08/20/2025
Certification Date: 11/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

881 USS JAMES MADISON ROAD
KINGS BAY GA
31547-0000
US

IV. Provider business mailing address

10651 E. STREET BLDG. H-100
CORPUS CHRISTI TX
78419
US

V. Phone/Fax

Practice location:
  • Phone: 912-573-6450
  • Fax: 813-653-9669
Mailing address:
  • Phone: 361-961-6163
  • Fax: 813-653-9669

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083A0100X
TaxonomyAerospace Medicine Physician
License NumberME 57015
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2083P0500X
TaxonomyPreventive Medicine/Occupational Environmental Medicine Physician
License NumberME 57015
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License NumberME 57015
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code2083T0002X
TaxonomyMedical Toxicology (Preventive Medicine) Physician
License NumberME 57015
License Number StateFL
# 5
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License NumberME 57015
License Number StateFL
# 6
Primary TaxonomyN
Taxonomy Code202C00000X
TaxonomyIndependent Medical Examiner Physician
License NumberME 57015
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: