Provider Demographics
NPI:1053307660
Name:GUERRERO, RAUL V (MD)
Entity Type:Individual
Prefix:DR
First Name:RAUL
Middle Name:V
Last Name:GUERRERO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1614 E NORRIS DR
Mailing Address - Street 2:
Mailing Address - City:OTTAWA
Mailing Address - State:IL
Mailing Address - Zip Code:61350-3681
Mailing Address - Country:US
Mailing Address - Phone:815-433-1010
Mailing Address - Fax:815-433-0067
Practice Address - Street 1:1614 E NORRIS DR
Practice Address - Street 2:
Practice Address - City:OTTAWA
Practice Address - State:IL
Practice Address - Zip Code:61350-3681
Practice Address - Country:US
Practice Address - Phone:815-433-1010
Practice Address - Fax:815-433-0067
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2013-03-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL036079759207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036079759Medicaid
ILIL3078004Medicare PIN