Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 4301087270 | MI |
N | 111NI0900X | Internist | 4301087270 | MI |
Y | 207T00000X | Neurosurgeon | S3985 | TX |
N | 2084N0400X | Neurologist | 2013003475 | MO |
N | 2084V0102X | Vascular Neurology | S3985 | TX |
NPI | 1003032111 |
---|---|
Provider Name | Dr. Vikas Gupta |
First Address | Columbia, MO 65205-7687 |
Second Address | El Paso, TX 79905-2707 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/04/2007 |
Last Update Date | 14/04/2020 |