Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QG0300X | Family Doctor - Geriatric Medicine | MD0000035645 | TN |
NPI | 1225089725 |
---|---|
Provider Name | Dr. Rajeev Gupta |
First Address | Morristown, TN 37813-2832 |
Second Address | Morristown, TN 37813-2832 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/05/2006 |
Last Update Date | 28/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
080190473 | RAILROAD MEDICARE (01) | TN |
3879184 | (05) | TN |
H72688 | (02) | TN |