Healthcare Provider Details

I. General information

NPI: 1336193069
Provider Name (Legal Business Name): SANDEEP GUPTA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 04/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8220 WALNUT HILL LN SUITE 101
DALLAS TX
75231-4427
US

IV. Provider business mailing address

8220 WALNUT HILL LN SUITE 101
DALLAS TX
75231-4427
US

V. Phone/Fax

Practice location:
  • Phone: 214-369-1901
  • Fax: 214-369-1905
Mailing address:
  • Phone: 214-369-1901
  • Fax: 214-369-1905

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License NumberL8357
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: