Individual
ASHUTOSH GUPTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
540 W 5TH ST, SUITE 300, ODESSA, TX 79761-5034
(432) 640-3007
(432) 640-2708
Mailing address
PO BOX 2129, ODESSA, TX 79760-2129
(432) 640-3007
(432) 640-2708
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
Q1410
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201024310
—
IN
01
—
P01002367
RAILROAD MEDICARE PTAN
IN
Enumeration date
01/03/2009
Last updated
06/25/2015
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