Healthcare Provider Details

I. General information

NPI: 1770996902
Provider Name (Legal Business Name): JOHN MICHAEL GUTHRIE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2014
Last Update Date: 12/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HOAG DR
NEWPORT BEACH CA
92663-4162
US

IV. Provider business mailing address

1 HOAG DR, PO BOX 6100 - CRITICAL CARE
NEWPORT BEACH, CA CA
92658
US

V. Phone/Fax

Practice location:
  • Phone: 949-764-6874
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberA134473
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberA134473
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License NumberA134473
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: