Provider Demographics
NPI:1730118415
Name:GUPTA AND GUPTA PEDIATRICS MD PA
Entity Type:Organization
Organization Name:GUPTA AND GUPTA PEDIATRICS MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PREM
Authorized Official - Middle Name:P
Authorized Official - Last Name:GUPTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:432-685-5029
Mailing Address - Street 1:302 SECOR ST
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79701-6343
Mailing Address - Country:US
Mailing Address - Phone:432-685-5029
Mailing Address - Fax:432-685-3968
Practice Address - Street 1:302 SECOR ST
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79701-6343
Practice Address - Country:US
Practice Address - Phone:432-685-5029
Practice Address - Fax:432-685-3968
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0095JQOtherBCBS TX
TX0095JQOtherBCBS TX