Individual
SHAILESH GUPTA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
12 CADENA DR, GALVESTON, TX 77554-6329
(409) 740-1558
(409) 740-1558
Mailing address
12 CADENA DR, GALVESTON, TX 77554-6329
(409) 740-1558
(409) 740-1558
Taxonomy
Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
Primary
01054492A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11501477
CAQH NUMBER
IN
05
—
200533870
—
IN
Enumeration date
05/25/2006
Last updated
07/27/2007
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