=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558674747
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RAJESH KUMAR GUPTA M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/16/2010
-----------------------------------------------------
Last Update Date | 09/27/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8901 BOONE RD
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77099
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-454-0500
-----------------------------------------------------
Fax | 713-512-2239
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6431 FANNIN ST STE 7.044
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77030-1501
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-325-7080
-----------------------------------------------------
Fax | 713-512-2239
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084N0400X
-----------------------------------------------------
Taxonomy Name | Neurology Physician
-----------------------------------------------------
License Number | S2985
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2084N0600X
-----------------------------------------------------
Taxonomy Name | Clinical Neurophysiology Physician
-----------------------------------------------------
License Number | S2985
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------