Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 41311 | CO |
NPI | 1043298870 |
---|---|
Provider Name | Dr. Sanjay K Gupta |
First Address | Greeley, CO 80634-8386 |
Second Address | Greeley, CO 80634-8386 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/01/2006 |
Last Update Date | 18/11/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
80585019 | (05) | CO |
F60795 | (02) | CO |