Provider Demographics
NPI:1063489383
Name:GUPTA, SUNIL (MD)
Entity Type:Individual
Prefix:
First Name:SUNIL
Middle Name:
Last Name:GUPTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5150 N DAVIS HWY
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-2030
Mailing Address - Country:US
Mailing Address - Phone:850-476-6759
Mailing Address - Fax:850-484-5222
Practice Address - Street 1:5150 N DAVIS HWY
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-2030
Practice Address - Country:US
Practice Address - Phone:850-476-6759
Practice Address - Fax:850-484-5222
Is Sole Proprietor?:No
Enumeration Date:2006-03-06
Last Update Date:2018-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD.18753207W00000X, 207WX0107X
FLME66379207W00000X, 207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009976780Medicaid
AL009977830Medicaid
4534648OtherAETNA
AL009976770Medicaid
FL375444800Medicaid
AL009935465Medicaid
TN3007538OtherBCBS
ALMD.18753OtherMEDICAL LICENSE
AL059036515OtherBCBS
FLME66379OtherMEDICAL LICENSE
AL000038373Medicaid
FL25426OtherBCBS
5381541OtherCIGNA
AL051038373OtherBCBS
AL051025664OtherBCBS
AL059156733OtherBCBS
FLF31876Medicare UPIN
AL009976780Medicaid
AL059036515OtherBCBS
4534648OtherAETNA