Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VE0102X | Reproductive Endocrinologist | MD047469L | PA |
NPI | 1063579431 |
---|---|
Provider Name | Dr. Jacqueline Gutmann |
First Address | Willow Grove, PA 19090-1338 |
Second Address | Philadelphia, PA 19107-4414 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/01/2007 |
Last Update Date | 21/10/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D98418 | (02) | PA |