Provider Demographics
NPI:1578520458
Name:DASGUPTA, DEBASISH (MD)
Entity Type:Individual
Prefix:
First Name:DEBASISH
Middle Name:
Last Name:DASGUPTA
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:PO BOX 846098
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-6098
Mailing Address - Country:US
Mailing Address - Phone:903-531-5000
Mailing Address - Fax:
Practice Address - Street 1:800 E DAWSON ST
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-2036
Practice Address - Country:US
Practice Address - Phone:903-510-1186
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2017-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01056530A207R00000X
TXP4298207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX75-2616977-042OtherTRICARE
TX8DJ983OtherBCBS
TXP01092666OtherMCRRR
IN200425520Medicaid
IN000000289034OtherANTHEM
TX306275401Medicaid
TX8HN121OtherBCBS
TXP01092666OtherMCRRR
IN200425520Medicaid
INH80476Medicare UPIN