DR. THEODORE BRYAN GUPTON JR. (NPI# 1790019347) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1790019347 |
| Entity Type | Individual |
| Full Name | DR. THEODORE BRYAN GUPTON JR. |
| Credential | M.D. |
| Practice Address |
815 Pennsylvania Ave Fort Worth TX 76104-2224 |
| Mailing Address |
816 W Cannon Street Fort Worth TX 76104 |
| Practice Telephone | 8173210404 |
| Mailing Telephone | 8173210404 |
| Enumeration Date | 2009-09-30 |
| Last Update Date | 2019-11-11 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 2085R0202X |
Radiology Specialization: Diagnostic Radiology |
Q2900 | TX | Allopathic & Osteopathic Physicians |
| Y | 2085R0204X |
Radiology Specialization: Vascular & Interventional Radiology |
Q2900 | TX | Allopathic & Osteopathic Physicians |
| Street Address |
815 PENNSYLVANIA AVE |
| City | FORT WORTH |
| State | TX |
| Zip Code | 76104-2224 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184627994 | David A Fenyes | Radiology | 815 Pennsylvania Ave, Fort Worth, TX 76104-2224 | 2005-05-24 |
| 1457972853 | Robert W Pasquini Jr. | Physician Assistant | 815 Pennsylvania Ave, Fort Worth, TX 76104-2224 | 2020-04-27 |
| 1396215059 | Rebeca Ji Hae Kim Stanley | Physician Assistant | 815 Pennsylvania Ave, Fort Worth, TX 76104-2224 | 2018-11-26 |
| 1710423884 | Isuri Weerasinghe | Physician Assistant | 815 Pennsylvania Ave, Fort Worth, TX 76104 | 2017-01-13 |
| 1255759437 | Ali Alian | Radiology | 815 Pennsylvania Ave, Fort Worth, TX 76104-2224 | 2014-04-03 |
| 1396166039 | Health Imaging Partners, LLC | Physiological Laboratory | 815 Pennsylvania Ave, Fort Worth, TX 76104-2224 | 2013-12-24 |
| 1427482280 | Magda Rizer I | Radiology | 815 Pennsylvania Ave, Fort Worth, TX 76104 | 2013-08-29 |
| 1033556311 | Vivek Gowdra Halappa | Radiology | 815 Pennsylvania Ave, Fort Worth, TX 76104-2224 | 2013-05-28 |
| 1194169847 | Justin Manuel Ramirez | Radiology | 815 Pennsylvania Ave, Fort Worth, TX 76104-2224 | 2013-04-24 |
| 1508209495 | Ethan Boothe | Radiology | 815 Pennsylvania Ave, Fort Worth, TX 76104-2224 | 2013-04-10 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669082186 | Cvs Pharmacy, Inc. | Durable Medical Equipment & Medical Supplies | 1115 8th St, Fort Worth, TX 76104 | 2020-08-10 |
| 1992343693 | Iris Giove | Psychologist | John Peter Smith Hospital, 1500 S. Main St., Fort Worth, TX 76104 | 2019-12-13 |
| 1104480656 | Swarnalaxmi Umapathy | Student in an Organized Health Care Education/Training Program | 900 8th Avenue, Fort Worth, TX 76104 | 2019-04-30 |
| 1881189132 | Mega Surgical Assistants LLC | Specialist/Technologist, Other | 1301pennsylvania, Fort Worth, TX 76104 | 2018-06-28 |
| 1356848899 | Tricia Kelly | Nurse Practitioner | 1325 Pennsylvania Avenue Suite 560, Fort Worth, TX 76104 | 2018-04-11 |
| 1952820979 | Modern Vein Clinic | Internal Medicine | 757 8th Avenue, Suite A, Forth Worth, TX 76104 | 2017-09-11 |
| 1790207165 | Vanessa Abbood | Dietitian, Registered | 900 Eighth Ave, Fns Department, Fort Worth, TX 76104 | 2017-07-07 |
| 1922537562 | Nicole Marie Tod | Student in an Organized Health Care Education/Training Program | 1500 S Main Street, Fort Worth, TX 76104 | 2017-06-07 |
| 1770025934 | Micah Bonola | Chiropractor | 1300 W. Rosedale St, Ste. A, Fort Worth, TX 76104 | 2016-11-04 |
| 1518315894 | United Bioscience, LLC. | Clinical Medical Laboratory | 901 W. Leuda St., B, Fort Worth, TX 76104 | 2016-05-27 |
| Find all providers in zip 76104 | ||||
| Taxonomy Code | 2085R0204X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Radiology |
| Specialization | Vascular & Interventional Radiology |
| A radiologist who diagnoses and treats diseases by various radiologic imaging modalities. These include fluoroscopy, digital radiography, computed tomography, sonography and magnetic resonance imaging. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added] Additional Resources: American Board of Radiology, 2007. http://www.theabr.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Radiology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346463999 | James Bradley Beard | Radiology | 6501 Shoal Creek Rd, Fort Worth, TX 76132-4418 | 2007-04-11 |
| 1710970975 | Radiology Associates of North Texas, Pa | Radiology | 816 W Cannon St, Credentialing 1710970975, Fort Worth, TX 76104-3146 | 2005-08-23 |
| 1164849154 | Mohammad Toliyat | Radiology | 816 W Cannon St, Fort Worth, TX 76104-3146 | 2014-03-27 |
| 1699902320 | Scott G. Smith | Radiology | 815 Pennsylvania Ave, Fort Worth, TX 76104-2224 | 2009-06-21 |
| 1255306312 | Benjamin Merrick Crandall | Radiology | 815 Pennsylvania Ave, Fort Worth, TX 76104-2224 | 2006-02-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588290340 | Mission Vascular Specialists Corp | Radiology | 718 Lexington Ave Fl 1, San Antonio, TX 78212-4768 | 2020-03-12 |
| 1568095891 | Interventional Partners LLC | Radiology | 4323 N Josey Ln Ste 200, Carrollton, TX 75010-4619 | 2020-02-14 |
| 1467085795 | Interventional Partners LLC | Radiology | 400 W Arbrook Blvd Ste 320, Arlington, TX 76014-3180 | 2020-02-14 |
| 1447883772 | Interventional Partners LLC | Radiology | 3400 Interstate Highway 30 Ste 180, Mesquite, TX 75150-2601 | 2020-02-14 |
| 1649811571 | Amh Ir LLC | Radiology | 4425 Bluestem St, Flower Mound, TX 75028-1123 | 2019-10-02 |
| 1497300081 | Minimally Invasive Surgical Pllc | Radiology | 4532 N Mesa St Ste B2, El Paso, TX 79912-6286 | 2019-08-09 |
| 1922666189 | Interventional Partners, LLC | Radiology | 251 W Medical Center Blvd Ste 200, Webster, TX 77598-4242 | 2019-06-03 |
| 1922563410 | Virtx LLC | Radiology | 13284 Bigelow Ln, Frisco, TX 75035-0782 | 2019-02-08 |
| 1831688779 | Humble Interventional Partners Md Pa | Radiology | 8411 Fm 1960 Bypass Rd W, Humble, TX 77338-4013 | 2018-05-07 |
| 1386163780 | Sunrise Vascular Pllc | Radiology | 2715 Boca Chica Blvd Ste 3, Brownsville, TX 78521-3676 | 2017-09-18 |
| Find all providers with the same taxonomy | ||||
| City | FORT WORTH |
| Zip Code | 76104 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.