Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | M7234 | TX |
Y | 111NI0900X | Internist | M7234 | TX |
NPI | 1003007022 |
---|---|
Provider Name | Dr. Mamta Gupta |
First Address | Dallas, TX 75246-1905 |
Second Address | Dallas, TX 75246-1800 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/08/2007 |
Last Update Date | 26/10/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8AL361 | BCBS (01) | TX |