Provider Demographics
NPI:1386630473
Name:GUTTELL, JOHN S (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:S
Last Name:GUTTELL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1 PEARL ST
Mailing Address - Street 2:SUITE 1000
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-2864
Mailing Address - Country:US
Mailing Address - Phone:508-897-6070
Mailing Address - Fax:508-897-6073
Practice Address - Street 1:1 PEARL ST
Practice Address - Street 2:SUITE 1000
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-2864
Practice Address - Country:US
Practice Address - Phone:508-897-6070
Practice Address - Fax:508-897-6075
Is Sole Proprietor?:No
Enumeration Date:2005-09-23
Last Update Date:2011-08-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA41880207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2072645Medicaid
MAC04798Medicare ID - Type Unspecified
MA2072645Medicaid