Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | G22947 | CA |
NPI | 1114080611 |
---|---|
Provider Name | Dr. Eric I Gutnick |
First Address | Fort Bragg, CA 95437 |
Second Address | Fort Bragg, CA 95437 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/12/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
44448956Y | (05) | CA |
A41785 | (02) |