Provider Demographics
NPI:1093726895
Name:GUTTAS, JEFFREY JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:JOHN
Last Name:GUTTAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 S SAN MATEO DR
Mailing Address - Street 2:SUITE 400
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94401-3805
Mailing Address - Country:US
Mailing Address - Phone:650-696-4100
Mailing Address - Fax:650-696-4121
Practice Address - Street 1:100 S SAN MATEO DR
Practice Address - Street 2:SUITE 400
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94401-3805
Practice Address - Country:US
Practice Address - Phone:650-696-4100
Practice Address - Fax:650-696-4121
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG612560207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G612560Medicaid
CA00G612560Medicaid
CA00G612560Medicare ID - Type Unspecified