Provider Demographics
NPI:1497850523
Name:GUP, RONALD STUART (MD)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:STUART
Last Name:GUP
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 1:4060 SHERIDAN ST STE A
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-3559
Mailing Address - Country:US
Mailing Address - Phone:195-496-6900
Mailing Address - Fax:954-985-0456
Practice Address - Street 1:4060 SHERIDAN ST
Practice Address - Street 2:SUITE B
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-3559
Practice Address - Country:US
Practice Address - Phone:954-966-9001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL44479207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL94302Medicare ID - Type Unspecified