Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 01059929A | IN |
NPI | 1023175478 |
---|---|
Provider Name | Dr. Jason J Gutt |
First Address | Indianapolis, IN 46260-5350 |
Second Address | Indianapolis, IN 46237-6341 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/01/2007 |
Last Update Date | 18/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200507230 | (05) | IN |
I30558 | (02) | IN |
P00225989 | MEDICARE RAILROAD (01) | IN |