Provider Demographics
NPI:1912560152
Name:GUPTA, JAVAS (MD)
Entity Type:Individual
Prefix:
First Name:JAVAS
Middle Name:
Last Name:GUPTA
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 1:3378 MARINER BLVD
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34609-2460
Mailing Address - Country:US
Mailing Address - Phone:352-796-7171
Mailing Address - Fax:352-684-6843
Practice Address - Street 1:3378 MARINER BLVD
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34609-2460
Practice Address - Country:US
Practice Address - Phone:352-796-7171
Practice Address - Fax:352-684-6843
Is Sole Proprietor?:No
Enumeration Date:2019-04-14
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLME156716207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program