Individual
ANJALI GUPTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1320 S BAY ST, EUSTIS, FL 32726-5551
(352) 530-9557
(352) 602-7149
Mailing address
1320 S BAY ST, EUSTIS, FL 32726-5551
(352) 530-9557
(352) 602-7149
Taxonomy
Speciality
Code
Description
License number
State
2084A0401X
Addiction Medicine (Psychiatry & Neurology) Physician
036129588
IL
2084A0401X
Addiction Medicine (Psychiatry & Neurology) Physician
Primary
ME136879
FL
2085R0001X
Radiation Oncology Physician
37462
IA
2085R0001X
Radiation Oncology Physician
MD063886L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0016869060001
—
PA
01
—
70640
WELLMARK BCBS
IA
01
—
ME136879
MEDICAL LICENSE
FL
Enumeration date
07/07/2006
Last updated
10/23/2019
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