Individual
SHIVA GUPTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
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
Update your record
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