Provider Demographics
NPI:1598081416
Name:GUTHRIE, JENNIFER LEE (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:LEE
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 1:224 DATURA ST STE 315
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401-5631
Mailing Address - Country:US
Mailing Address - Phone:561-214-3323
Mailing Address - Fax:561-828-6247
Practice Address - Street 1:224 DATURA ST STE 315
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-5631
Practice Address - Country:US
Practice Address - Phone:561-214-3323
Practice Address - Fax:561-828-6247
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-16
Last Update Date:2018-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME125307208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
1821505215OtherNPPES
FLME125307OtherFL LICENSE