Individual
DR. THEODORE BRYAN GUPTON JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
815 PENNSYLVANIA AVE, FORT WORTH, TX 76104-2224
(817) 321-0404
Mailing address
816 W CANNON STREET, FORT WORTH, TX 76104
(817) 321-0404
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
Q2900
TX
2085R0204X
Vascular & Interventional Radiology Physician
Q2900
TX
Other
Enumeration date
09/30/2009
Last updated
06/20/2024
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