Provider Demographics
NPI:1508816265
Name:GUPTA, TEMPLE (PA-C)
Entity Type:Individual
Prefix:
First Name:TEMPLE
Middle Name:
Last Name:GUPTA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3015 HIGHWAY 95
Mailing Address - Street 2:
Mailing Address - City:BULLHEAD CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86442-4334
Mailing Address - Country:US
Mailing Address - Phone:928-763-5055
Mailing Address - Fax:928-765-5056
Practice Address - Street 1:3015 HIGHWAY 95
Practice Address - Street 2:
Practice Address - City:BULLHEAD CITY
Practice Address - State:AZ
Practice Address - Zip Code:86442-4334
Practice Address - Country:US
Practice Address - Phone:928-763-5055
Practice Address - Fax:928-763-5056
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2013-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3418363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical