Provider Demographics
NPI:1891894325
Name:GUTIERREZ, JOSE F (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:F
Last Name:GUTIERREZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6001 VINELAND RD
Mailing Address - Street 2:SUITE #101
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-7829
Mailing Address - Country:US
Mailing Address - Phone:407-352-0573
Mailing Address - Fax:407-363-6899
Practice Address - Street 1:6001 VINELAND RD
Practice Address - Street 2:SUITE #101
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-7829
Practice Address - Country:US
Practice Address - Phone:407-352-0573
Practice Address - Fax:407-363-6899
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2012-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0043084207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL068183100Medicaid
FL47597Medicare ID - Type Unspecified
FL068183100Medicaid