Provider Demographics
NPI:1750310710
Name:GUTIERREZ, RUY (MD)
Entity type:Individual
Prefix:DR
First Name:RUY
Middle Name:
Last Name:GUTIERREZ
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:P.O. BOX 1849
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04241-1849
Mailing Address - Country:US
Mailing Address - Phone:207-784-2554
Mailing Address - Fax:207-777-5363
Practice Address - Street 1:300 MAIN ST.
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240
Practice Address - Country:US
Practice Address - Phone:207-795-8320
Practice Address - Fax:207-795-8329
Is Sole Proprietor?:No
Enumeration Date:2006-07-02
Last Update Date:2009-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME011190207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME010313237OtherTUFTS HEALTH PLAN
MAM775OtherHEALTHSOURCE MA
ME010313237OtherGREAT WEST HEALTHCARE
ME2216523OtherAETNA ME
ME430012433OtherRAILROAD MEDICARE
ME010313237OtherCIGNA
MEE21238OtherHARVARD PILGRIM
MEM0140OtherBCBS ME
MEMM2536Medicare ID - Type Unspecified
ME430012433OtherRAILROAD MEDICARE