Provider Demographics
NPI:1881652956
Name:GUPTA, SUBHASH C (MD)
Entity Type:Individual
Prefix:
First Name:SUBHASH
Middle Name:C
Last Name:GUPTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:601 E. SAMPLE ROAD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33064
Mailing Address - Country:US
Mailing Address - Phone:954-344-2522
Mailing Address - Fax:954-344-9189
Practice Address - Street 1:601 E SAMPLE ROAD
Practice Address - Street 2:SUITE 105
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33064
Practice Address - Country:US
Practice Address - Phone:954-943-1133
Practice Address - Fax:954-783-6845
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-01
Last Update Date:2012-05-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME43566207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL042423400Medicaid
FL042423400Medicaid
FLD63209Medicare UPIN
94324XMedicare PIN