Provider Demographics
NPI:1821616772
Name:GUEDRY, MITCHELL (MD)
Entity Type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:
Last Name:GUEDRY
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 1:1414 KUHL AVE # MP31
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-2008
Mailing Address - Country:US
Mailing Address - Phone:407-841-5133
Mailing Address - Fax:407-237-6313
Practice Address - Street 1:1414 KUHL AVE # MP31
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-2008
Practice Address - Country:US
Practice Address - Phone:407-841-5133
Practice Address - Fax:407-237-6313
Is Sole Proprietor?:No
Enumeration Date:2020-07-08
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA340977207P00000X
FLME161700207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine