Basic Information
| Provider Information | |||||||||
| NPI: | 1437600624 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GUPTA | ||||||||
| FirstName: | RAVI | ||||||||
| MiddleName: | KUMAR | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 616788 | ||||||||
| Address2: | |||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328616788 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4074477120 | ||||||||
| FaxNumber: | 4077700661 | ||||||||
| Practice Location | |||||||||
| Address1: | 2900 E TEXAS ST STE 100 | ||||||||
| Address2: | |||||||||
| City: | BOSSIER CITY | ||||||||
| State: | LA | ||||||||
| PostalCode: | 711113275 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3186066737 | ||||||||
| FaxNumber: | 8337490343 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/22/2016 | ||||||||
| LastUpdateDate: | 07/12/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/12/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 327881 | LA | Y | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | DR.0063442 | CO | N | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.