1063489383 NPI number — SUNIL GUPTA M.D.

Table of content: SUNIL GUPTA M.D. (NPI 1063489383)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063489383 NPI number — SUNIL GUPTA M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GUPTA
Provider First Name:
SUNIL
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1063489383
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/21/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5150 N DAVIS HWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PENSACOLA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32503-2030
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
850-476-6759
Provider Business Mailing Address Fax Number:
850-484-5222

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5150 N DAVIS HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PENSACOLA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32503-2030
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
850-476-6759
Provider Business Practice Location Address Fax Number:
850-484-5222
Provider Enumeration Date:
03/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  MD.18753 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207W00000X , with the licence number: ME66379 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207WX0107X , with the licence number: MD.18753 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207WX0107X , with the licence number: ME66379 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 009976780 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 009977830 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4534648 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 009976770 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 375444800 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 009935465 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3007538 . This is a "BCBS" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: MD.18753 . This is a "MEDICAL LICENSE" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 059036515 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: ME66379 . This is a "MEDICAL LICENSE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 000038373 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 25426 . This is a "BCBS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 5381541 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 051038373 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 051025664 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 059156733 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 375444800 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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