Organization
GASTRO MD FLORIDA, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VISHAL GUPTA MD (PRESIDENT)
(386) 668-2221
Entity
Organization
Contact information
Practice address
2884 WELLNESS AVE STE 100, ORANGE CITY, FL 32763-8427
(386) 668-2221
(386) 668-2228
Mailing address
2884 WELLNESS AVE STE 100, ORANGE CITY, FL 32763-8427
(386) 668-2221
(386) 668-2228
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
—
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
AB449
PTAN
FL
Enumeration date
11/07/2006
Last updated
11/10/2020
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