Provider Demographics
NPI:1518917921
Name:GUERRA, GUERRUMBERTO JOSE (MD)
Entity Type:Individual
Prefix:DR
First Name:GUERRUMBERTO
Middle Name:JOSE
Last Name:GUERRA
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 1:6005 PARK AVE
Mailing Address - Street 2:SUITE 500B
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-5202
Mailing Address - Country:US
Mailing Address - Phone:901-683-6925
Mailing Address - Fax:901-684-1435
Practice Address - Street 1:6005 PARK AVE
Practice Address - Street 2:SUITE 500B
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-5202
Practice Address - Country:US
Practice Address - Phone:901-683-6925
Practice Address - Fax:901-684-1435
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN08571207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3177887Medicare ID - Type Unspecified
TN3177885Medicare ID - Type Unspecified
TNB59402Medicare UPIN