Individual
ANIMESH GUPTA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
190 E BANNOCK ST, BOISE, ID 83712-6241
(208) 381-7335
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
M-16817
ID
Other
Enumeration date
07/17/2017
Last updated
07/06/2023
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