Individual
AMIT GUPTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
134 VISION PARK BLVD STE 100, SHENANDOAH, TX 77384-3030
(936) 242-1437
(936) 447-9672
Mailing address
134 VISION PARK BLVD STE 100, SHENANDOAH, TX 77384-3030
Taxonomy
Speciality
Code
Description
License number
State
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
20A11210
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
20A11210
MEDICAL LICENSE
CA
01
—
S9139
MEDICAL LICENSE
TX
Enumeration date
01/17/2007
Last updated
07/18/2023
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