Healthcare Provider Details

I. General information

NPI: 1427040963
Provider Name (Legal Business Name): JOSE M GUECO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/19/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33B TROLLEY SQ
WILMINGTON DE
19806-3352
US

IV. Provider business mailing address

33B TROLLEY SQ
WILMINGTON DE
19806-3352
US

V. Phone/Fax

Practice location:
  • Phone: 302-654-0997
  • Fax: 302-654-9253
Mailing address:
  • Phone: 302-654-0997
  • Fax: 302-654-9253

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberC10000871
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: