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Organization
SUNIL GUPTA MD LLC
Active
Organization
SUNIL GUPTA MD LLC
Active
Other names
Retina Specialty Institute
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SUNIL GUPTA M.D. (MANAGING MEMBER)
(850) 476-6759
Entity
Organization
Contact information
Practice address
5150 N DAVIS HWY, PENSACOLA, FL 32503-2030
(850) 476-6759
(850) 484-5222
Mailing address
5150 N DAVIS HWY, PENSACOLA, FL 32503-2030
(850) 476-6759
(850) 484-5222
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
ME66379
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
07331062
MEDICAID
MS
05
—
09016091
—
MS
05
—
267921300
—
FL
01
—
34843
BLUE CROSS PROVIDER GROUP
FL
05
—
529917080
—
AL
Enumeration date
05/26/2006
Last updated
08/31/2011
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