Individual
DR. AJAY K GUPTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4515 SETON CENTER PKWY STE 220, AUSTIN, TX 78759
(512) 338-8388
(512) 406-6274
Mailing address
6210 E US HWY 290, STE. 420 - CREDENTIALING, AUSTIN, TX 78759-5785
(512) 338-3826
(512) 406-6216
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
J8562
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
124005307
—
TX
05
—
124005308
—
TX
01
—
82T248
BCBSTX PROVIDER NUMB
TX
Enumeration date
05/05/2006
Last updated
05/08/2019
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