Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 5085712-1205 | UT |
N | 111NI0900X | Internist | 5085712-1205 | UT |
Y | 207RG0300X | Geriatric Medicine | 5085712-1205 | UT |
N | 207RX0202X | Medical Oncology | 5085712-1205 | UT |
NPI | 1003906603 |
---|---|
Provider Name | Sumati Virendra Gupta |
First Address | Salt Lake City, UT 84102 |
Second Address | Salt Lake City, UT 84112-5550 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/10/2006 |
Last Update Date | 02/11/2021 |