Provider Demographics
NPI:1659450989
Name:GUENTER, DOUGLAS PAUL (DOUGLAS GUENTER)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:PAUL
Last Name:GUENTER
Suffix:
Gender:M
Credentials:DOUGLAS GUENTER
Other - Prefix:
Other - First Name:DOUGLAS
Other - Middle Name:
Other - Last Name:GUENTER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:110 W UTICA ST
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:NY
Mailing Address - Zip Code:13126-3047
Mailing Address - Country:US
Mailing Address - Phone:315-342-2024
Mailing Address - Fax:
Practice Address - Street 1:110 W UTICA ST
Practice Address - Street 2:
Practice Address - City:OSWEGO
Practice Address - State:NY
Practice Address - Zip Code:13126-3047
Practice Address - Country:US
Practice Address - Phone:315-342-2024
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY238616207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02837098Medicaid
NYJ400005089Medicare PIN