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General NPI Number Information
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NPI Number | 1316910433
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Entity Type | Individual
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Provider Name | GANESH PRASAD GUPTA MD
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Gender | Male
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Dates
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Enumeration Date | 02/09/2006
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Last Update Date | 07/12/2010
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Provider Practice Location Address
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Address Line | 1610 JAMES BOWIE DR STE A114
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City | BAYTOWN
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State | TX
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Zip | 77520
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Country | US
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Telephone | 281-422-3576
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Fax | 281-422-0295
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Provider Business Mailing Address
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Address Line | PO BOX 975
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City | BAYTOWN
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State | TX
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Zip | 77522-0975
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Country | US
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Telephone | 281-422-3576
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Fax | 281-422-0295
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | J4649
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License Number State | TX
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