Provider Demographics
NPI:1518053503
Name:GUERRERO, M.D., PLLC, ISMAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:ISMAEL
Middle Name:
Last Name:GUERRERO, M.D., PLLC
Suffix:
Gender:M
Credentials:MD
Other - Prefix:MR
Other - First Name:ISMAEL
Other - Middle Name:INCLAN
Other - Last Name:GUERRERO, M.D., PLC
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1965 W. 24TH STREET
Mailing Address - Street 2:SUITE A
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-6255
Mailing Address - Country:US
Mailing Address - Phone:928-344-5774
Mailing Address - Fax:928-344-5779
Practice Address - Street 1:1965 W. 24TH STREET
Practice Address - Street 2:SUITE A
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-6255
Practice Address - Country:US
Practice Address - Phone:928-344-5774
Practice Address - Fax:928-344-5779
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2013-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ21545207QA0505X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ139841 001Medicaid
AZA89964Medicare UPIN
AZZ82392Medicare PIN