Provider Demographics
NPI:1346446275
Name:GUTIERREZ, LOUISE LANE LUCERO (MD)
Entity Type:Individual
Prefix:DR
First Name:LOUISE LANE
Middle Name:LUCERO
Last Name:GUTIERREZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10460 ROOSEVELT BLVD N # 169
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33716-3821
Mailing Address - Country:US
Mailing Address - Phone:727-420-6374
Mailing Address - Fax:813-355-0810
Practice Address - Street 1:1258 WEST BAY DRIVE
Practice Address - Street 2:SUITE D
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33770-2200
Practice Address - Country:US
Practice Address - Phone:727-420-6374
Practice Address - Fax:813-355-0810
Is Sole Proprietor?:No
Enumeration Date:2007-06-26
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME116559207RI0200X
GUM-2314207RI0200X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease