Provider Demographics
NPI:1922061589
Name:GUTOWSKI, GREGG W (MD)
Entity Type:Individual
Prefix:
First Name:GREGG
Middle Name:W
Last Name:GUTOWSKI
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 1:507 W. ALEXANDER ST
Mailing Address - Street 2:
Mailing Address - City:PLANT CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33563-7136
Mailing Address - Country:US
Mailing Address - Phone:813-754-3504
Mailing Address - Fax:813-752-6863
Practice Address - Street 1:507 W ALEXANDER ST
Practice Address - Street 2:
Practice Address - City:PLANT CITY
Practice Address - State:FL
Practice Address - Zip Code:33563-7136
Practice Address - Country:US
Practice Address - Phone:813-754-3504
Practice Address - Fax:813-752-6863
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME46730207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL053622900Medicaid
FLME 46730OtherLICENSE NUMBER
AG1734323OtherDEA
AG1734323OtherDEA
FLME 46730OtherLICENSE NUMBER
C78750Medicare UPIN