Provider Demographics
NPI:1174825962
Name:GORDON P GUTHRIE, JR., M.D. PSC
Entity Type:Organization
Organization Name:GORDON P GUTHRIE, JR., M.D. PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:GORDON
Authorized Official - Middle Name:P
Authorized Official - Last Name:GUTHRIE
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:859-275-1943
Mailing Address - Street 1:PO BOX 1985
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40588-1985
Mailing Address - Country:US
Mailing Address - Phone:859-277-8179
Mailing Address - Fax:859-277-9320
Practice Address - Street 1:1780 NICHOLASVILLE ROAD
Practice Address - Street 2:SUITE 602
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-1400
Practice Address - Country:US
Practice Address - Phone:859-275-1943
Practice Address - Fax:859-277-8999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-30
Last Update Date:2011-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY18859207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64188592Medicaid
KY64188592Medicaid