Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | PA3622 | FL |
NPI | 1013928985 |
---|---|
Provider Name | Pete Gutierrez |
First Address | Miami, FL 33127-4901 |
Second Address | Miami, FL 33127-4901 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2006 |
Last Update Date | 10/06/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
P05571 | (02) | FL |