Provider Demographics
NPI:1609062439
Name:GUPTA, RENU (MD)
Entity Type:Individual
Prefix:
First Name:RENU
Middle Name:
Last Name:GUPTA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:760 GOLF VIEW DRIVE
Mailing Address - Street 2:SUITE #200
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-9685
Mailing Address - Country:US
Mailing Address - Phone:541-618-4400
Mailing Address - Fax:541-618-4406
Practice Address - Street 1:760 GOLF VIEW DRIVE
Practice Address - Street 2:SUITE #200
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-9685
Practice Address - Country:US
Practice Address - Phone:541-618-4400
Practice Address - Fax:541-618-4406
Is Sole Proprietor?:No
Enumeration Date:2007-09-14
Last Update Date:2018-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD154260174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist