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Individual

SHIVANI GUPTA

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
3680 NW SAMARITAN DR, CORVALLIS, OR 97330-3737
(541) 754-1150
Mailing address
444 NW ELKS DR, CORVALLIS, OR 97330-3745
(541) 754-1150

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
4301116991
MI
207RG0100X
Gastroenterology Physician
19882
WI
207RG0100X
Gastroenterology Physician
4301116991
MI
207RG0100X
Gastroenterology Physician
Primary
MD215020
OR
390200000X
Student in an Organized Health Care Education/Training Program

Other

Enumeration date
04/08/2013
Last updated
09/07/2023
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