Provider Demographics
NPI:1982876553
Name:GUTIERREZ, JAIME GABRIEL (MD)
Entity Type:Individual
Prefix:DR
First Name:JAIME
Middle Name:GABRIEL
Last Name:GUTIERREZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2309 ARTHUR AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10458-8103
Mailing Address - Country:US
Mailing Address - Phone:347-284-4500
Mailing Address - Fax:347-284-4982
Practice Address - Street 1:2309 ARTHUR AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10458-8103
Practice Address - Country:US
Practice Address - Phone:347-284-4500
Practice Address - Fax:347-284-4982
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-24
Last Update Date:2013-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME980622082S0105X, 2082S0099X, 208200000X
NY259768208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the Hand
No2082S0099XAllopathic & Osteopathic PhysiciansPlastic SurgeryPlastic Surgery Within the Head and Neck
No208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME98062OtherFLORIDA LICENSE
NY259768OtherNY MD LICENSE