Healthcare Provider Details

I. General information

NPI: 1326201260
Provider Name (Legal Business Name): DIPTESH RAMNARAIN GUPTA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2008
Last Update Date: 02/24/2020
Certification Date: 02/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6465 S YALE AVE STE 804
TULSA OK
74136-7810
US

IV. Provider business mailing address

6600 S YALE AVE STE 1400
TULSA OK
74136-3331
US

V. Phone/Fax

Practice location:
  • Phone: 918-502-3550
  • Fax: 918-502-3555
Mailing address:
  • Phone: 888-247-0125
  • Fax: 918-502-8001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number29614
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: