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Organization
SOUTHERN VASCULAR OF PANAMA CITY PLLC
Active
Organization
SOUTHERN VASCULAR OF PANAMA CITY PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ASHISH K GUPTA MD (PHYSICIAN/OWNER)
(850) 896-1696
Entity
Organization
Contact information
Practice address
1399 JENKS AVE # 12, PANAMA CITY, FL 32401-2442
(850) 532-6303
(850) 307-5402
Mailing address
1399 JENKS AVE # 12, PANAMA CITY, FL 32401-2442
(850) 532-6303
(850) 307-5402
Taxonomy
Speciality
Code
Description
License number
State
2086S0129X
Vascular Surgery Physician
Primary
—
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
004XT
FLORIDA BLUE
FL
01
—
DU2333
RAILROAD MEDICARE
FL
Enumeration date
09/03/2013
Last updated
09/16/2019
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