Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RH0003X | Hematology & Oncology | ME66255 | FL |
Y | 207RX0202X | Medical Oncology | ME66255 | FL |
NPI | 1073500328 |
---|---|
Provider Name | Troy H Guthrie JR. |
First Address | Fort Myers, FL 33907-1410 |
Second Address | Jacksonville, FL 32204 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2005 |
Last Update Date | 28/06/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000643574D | (05) | GA |
0533629-00 | (05) | FL |
1100398 | CAREPLUS (01) | FL |
1193085 | WELLCARE (01) | FL |
12687 | BCBS (01) | FL |
12687U | (02) | FL |
12687X | (02) | FL |
1614130 | CIGNA (01) | FL |
208075 | AVMED (01) | FL |
4402739 | AETNA (01) | FL |
D45516 | (02) | |
P01405056 | RR MEDICARE (01) | FL |
P01756757 | RR MEDICARE (01) | FL |