Provider Demographics
NPI:1356318653
Name:GUTER, MARVIN (MD)
Entity Type:Individual
Prefix:DR
First Name:MARVIN
Middle Name:
Last Name:GUTER
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 110099
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD RCH
Mailing Address - State:FL
Mailing Address - Zip Code:34211-0002
Mailing Address - Country:US
Mailing Address - Phone:941-755-6350
Mailing Address - Fax:
Practice Address - Street 1:15609 BUTTERFISH PL
Practice Address - Street 2:
Practice Address - City:LAKEWOOD RANCH
Practice Address - State:FL
Practice Address - Zip Code:34202
Practice Address - Country:US
Practice Address - Phone:941-755-6350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-06
Last Update Date:2010-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1171062085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01191359Medicaid
NY52019QMedicare ID - Type Unspecified
NY01191359Medicaid