Healthcare Provider Details

I. General information

NPI: 1053641233
Provider Name (Legal Business Name): JAIME G GUTIERREZ MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2010
Last Update Date: 01/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10454 NW 31ST TER
DORAL FL
33172-1200
US

IV. Provider business mailing address

PO BOX 310966
MIAMI FL
33231-0966
US

V. Phone/Fax

Practice location:
  • Phone: 305-477-9363
  • Fax: 305-468-0325
Mailing address:
  • Phone: 305-763-0880
  • Fax: 305-468-0325

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberME98062
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2082S0105X
TaxonomySurgery of the Hand (Plastic Surgery) Physician
License NumberME98062
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberME98062
License Number StateFL

VIII. Authorized Official

Name: DR. JAIME GABRIEL GUTIERREZ
Title or Position: PRESIDENT
Credential: MD
Phone: 305-763-0880