Provider Demographics
NPI:1932292562
Name:GUTTRIDGE, RANDALL J (DO)
Entity Type:Individual
Prefix:
First Name:RANDALL
Middle Name:J
Last Name:GUTTRIDGE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8202 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34668-6695
Mailing Address - Country:US
Mailing Address - Phone:727-819-1610
Mailing Address - Fax:727-868-0596
Practice Address - Street 1:8202 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34668-6695
Practice Address - Country:US
Practice Address - Phone:727-819-1610
Practice Address - Fax:727-868-0596
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2012-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS8673207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLTAX I.D. NUMBEROther593480541
FL0200484OtherUNITED HEALTHCARE I.D. #
FL51466ZMedicare ID - Type UnspecifiedMEDICARE I.D. NUMBER
FL0200484OtherUNITED HEALTHCARE I.D. #