Provider Demographics
NPI:1497868392
Name:GUTHRIE, ELLEN H (MD)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:H
Last Name:GUTHRIE
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:PO BOX 27128
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84127-0128
Mailing Address - Country:US
Mailing Address - Phone:801-408-1980
Mailing Address - Fax:801-233-4410
Practice Address - Street 1:3934 S 2300 E
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84124
Practice Address - Country:US
Practice Address - Phone:801-233-4400
Practice Address - Fax:801-233-4410
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT851734771205207P00000X
UT173477-1205207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT005806035Medicare PIN
UT005587610Medicare PIN
UT006985012Medicare PIN
UT005569178Medicare PIN
UT005586711Medicare PIN