Provider Demographics
NPI:1932133824
Name:GUTGSELL, HARALD (MD)
Entity Type:Individual
Prefix:
First Name:HARALD
Middle Name:
Last Name:GUTGSELL
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 1:1345 COYOTE RD
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86303-5334
Mailing Address - Country:US
Mailing Address - Phone:928-717-9796
Mailing Address - Fax:928-708-9789
Practice Address - Street 1:222 S SUMMIT AVE
Practice Address - Street 2:3
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86303-3780
Practice Address - Country:US
Practice Address - Phone:928-708-9788
Practice Address - Fax:928-708-9789
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ24589207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZG45966Medicare UPIN