Provider Demographics
NPI:1609872118
Name:GUTIERREZ, ALBERT RICHARD JR (MD)
Entity Type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:RICHARD
Last Name:GUTIERREZ
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:122 LINSLEY AVE
Mailing Address - Street 2:STE A
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-5121
Mailing Address - Country:US
Mailing Address - Phone:813-657-4914
Mailing Address - Fax:813-657-4916
Practice Address - Street 1:12037 CORTEZ BLVD
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34613-7349
Practice Address - Country:US
Practice Address - Phone:352-597-9008
Practice Address - Fax:352-597-1008
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME430832085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL26081Medicare ID - Type Unspecified
H79042Medicare UPIN