Individual
DR. MANISH GUPTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
777 WALTER REED BLVD, SUITE 201, GARLAND, TX 75042-5727
(972) 272-3417
(972) 487-1749
Mailing address
PO BOX 911230, DALLAS, TX 75391-1230
(972) 997-8000
(972) 437-9605
Taxonomy
Speciality
Code
Description
License number
State
207RX0202X
Medical Oncology Physician
Primary
L4411
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100845220A
—
OK
05
—
154481901
—
TX
05
—
154481902
—
TX
05
—
154481903
—
TX
05
—
154481904
—
TX
01
—
8R1452
BLUE CROSS OF TEXAS
TX
Enumeration date
06/12/2006
Last updated
05/05/2009
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