Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0129X | Vascular Surgeon | ME141203 | FL |
NPI | 1033409354 |
---|---|
Provider Name | Aashish P Gupta |
First Address | Rockledge, FL 32955-4306 |
Second Address | Cocoa Beach, FL 32931-3577 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/04/2011 |
Last Update Date | 30/08/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
103358500 | (05) | FL |
LN340 | MEDICARE (01) | FL |