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General NPI Number Information
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NPI Number | 1629026067
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Entity Type | Individual
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Provider Name | AJAY K GUPTA M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/05/2006
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Last Update Date | 05/08/2019
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Provider Practice Location Address
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Address Line | 4515 SETON CENTER PKWY STE 220
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City | AUSTIN
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State | TX
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Zip | 78759
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Country | US
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Telephone | 512-338-8388
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Fax | 512-406-6274
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Provider Business Mailing Address
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Address Line | 6210 E US HWY 290 STE. 420 - CREDENTIALING
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City | AUSTIN
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State | TX
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Zip | 78759-5785
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Country | US
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Telephone | 512-338-3826
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Fax | 512-406-6216
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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 | J8562
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License Number State | TX
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