Individual
SHIVA GUPTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1515 HOLCOMBE BLVD, HOUSTON, TX 77030-4000
(713) 792-6161
Mailing address
PO BOX 4439, HOUSTON, TX 77210-4439
(713) 792-2991
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
MD441926
PA
2085R0202X
Diagnostic Radiology Physician
Primary
P2865
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
301925901
MEDICAID TPI
—
Enumeration date
08/02/2011
Last updated
12/12/2012
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