Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 23335 | TX |
N | 204E00000X | Oral & Maxillofacial Surgeon | 23335 | TX |
NPI | 1568670495 |
---|---|
Provider Name | Rajesh Gutta |
First Address | Midland, TX 79701-6423 |
Second Address | Midland, TX 79701-6423 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/05/2007 |
Last Update Date | 31/03/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H01622 | (02) |