Provider Demographics
NPI:1306848734
Name:GUIDO, BRUCE PHILIP (MD)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:PHILIP
Last Name:GUIDO
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:PO BOX 1153
Mailing Address - Street 2:
Mailing Address - City:ASHTABULA
Mailing Address - State:OH
Mailing Address - Zip Code:44005-1153
Mailing Address - Country:US
Mailing Address - Phone:440-992-5555
Mailing Address - Fax:440-992-3310
Practice Address - Street 1:420 W 24TH ST
Practice Address - Street 2:
Practice Address - City:ASHTABULA
Practice Address - State:OH
Practice Address - Zip Code:44004-3421
Practice Address - Country:US
Practice Address - Phone:440-992-5555
Practice Address - Fax:440-992-3310
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35053469207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0629798Medicaid
OH0629798Medicaid
OHGU0657942Medicare ID - Type Unspecified