# SOUTHERN VASCULAR OF PANAMA CITY PLLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1699109181
- **Authorized official:** ASHISH K GUPTA MD (PHYSICIAN/OWNER)
- **Authorized official phone:** (850) 896-1696

## Contact information

- **Practice address:** 1399 JENKS AVE \# 12, PANAMA CITY, FL 32401-2442
- **Practice address phone:** (850) 532-6303
- **Practice address fax:** (850) 307-5402
- **Mailing address:** 1399 JENKS AVE \# 12, PANAMA CITY, FL 32401-2442
- **Mailing address phone:** (850) 532-6303
- **Mailing address fax:** (850) 307-5402

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2086S0129X | Vascular Surgery Physician | — | FL | Yes |

## Other

- **Enumeration date:** 09/03/2013
- **Last updated:** 09/16/2019

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 004XT | FLORIDA BLUE | FL |
| 01 | — | DU2333 | RAILROAD MEDICARE | FL |