Provider Demographics
NPI:1639256688
Name:GUTOWSKI, WATSON MARK (MD, FAAP, FACS)
Entity Type:Individual
Prefix:DR
First Name:WATSON
Middle Name:MARK
Last Name:GUTOWSKI
Suffix:
Gender:M
Credentials:MD, FAAP, FACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 14TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:SIDNEY
Mailing Address - State:MT
Mailing Address - Zip Code:59270-3521
Mailing Address - Country:US
Mailing Address - Phone:406-488-2100
Mailing Address - Fax:406-488-2261
Practice Address - Street 1:214 14TH AVE SW
Practice Address - Street 2:
Practice Address - City:SIDNEY
Practice Address - State:MT
Practice Address - Zip Code:59270-3521
Practice Address - Country:US
Practice Address - Phone:406-488-2100
Practice Address - Fax:406-488-2261
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2020-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT86559207Y00000X
KY27205207YX0602X, 207YX0901X, 207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No207YX0602XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngic Allergy
No207YX0901XAllopathic & Osteopathic PhysiciansOtolaryngologyOtology & Neurotology
Provider Identifiers
StateIdentifier IDID TypeIssuer
10-20165OtherUNITED HEALTHCARE
1089OtherCHA
KY27205OtherKY MEDICAL LICENSE
IN200163820Medicaid
OH35060286OtherOH MEDICAL LICENSE
4115248OtherAETNA
000000033755OtherANTHEM
IN100015770Medicaid
IN1046505OtherIN MEDICAL LICENSE
OH701342Medicaid
OH811429Medicaid
KY64272057Medicaid
IN1046505OtherIN MEDICAL LICENSE
4115248OtherAETNA
1089OtherCHA
IN172650-CMedicare ID - Type UnspecifiedIN GROUP NUMBER
IN100015770Medicaid