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General NPI Number Information
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NPI Number | 1457657090
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Entity Type | Organization
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Legal Business Name | GANESH P GUPTA MDPA
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Dates
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Enumeration Date | 01/30/2011
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Last Update Date | 01/30/2011
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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 | 77520-3383
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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 | PRESIDENT
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Name | MR. GANESH P GUPTA
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Credential | M.D.
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Telephone | 281-422-3576
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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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