Provider Demographics
NPI:1184011330
Name:GUTGLUECK, ERIC RYAN (MD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:RYAN
Last Name:GUTGLUECK
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 1:1691 W HORIZON RIDGE PKWY #100
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89012-3520
Mailing Address - Country:US
Mailing Address - Phone:702-450-8485
Mailing Address - Fax:702-804-1222
Practice Address - Street 1:7751 W FLAMINGO RD A100
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89147-4399
Practice Address - Country:US
Practice Address - Phone:702-450-8485
Practice Address - Fax:702-804-1222
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-24
Last Update Date:2020-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NV196882084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty