Provider Demographics
NPI:1174501340
Name:GUGENHEIM, STEPHEN (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:
Last Name:GUGENHEIM
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 1:3230 BEARD RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94558-3673
Mailing Address - Country:US
Mailing Address - Phone:707-224-7400
Mailing Address - Fax:707-224-7413
Practice Address - Street 1:3230 BEARD RD
Practice Address - Street 2:SUITE 2
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94558-3673
Practice Address - Country:US
Practice Address - Phone:707-224-7400
Practice Address - Fax:707-224-7413
Is Sole Proprietor?:No
Enumeration Date:2006-01-06
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL7739207YX0007X
CAG51162207YX0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & Neck
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACD069AOtherGROUP PTAN- MEDICARE
CACH435ZOtherINDIVIDUAL PTAN- MEDICARE