Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | ME94423 | FL |
NPI | 1003911975 |
---|---|
Provider Name | Dr. Luis Fernando Gutierrez |
First Address | Coral Springs, FL 33065-4046 |
Second Address | Coral Springs, FL 33065-4031 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/09/2006 |
Last Update Date | 20/07/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000052500 | (05) | FL |
10D0722060 | CLIA (01) | FL |
11936941 | CAQH (01) | FL |
921426220995003 | MEDICARE (01) | FL |
ME94423 | ME LICENSE (01) | FL |