Healthcare Provider Details

I. General information

NPI: 1780633875
Provider Name (Legal Business Name): JOSEPH GUTMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2006
Last Update Date: 08/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 NW 84TH AVE STE 200
PLANTATION FL
33324
US

IV. Provider business mailing address

4780 SW 64TH AVE STE 103
DAVIE FL
33314-4400
US

V. Phone/Fax

Practice location:
  • Phone: 954-424-4321
  • Fax: 954-424-0765
Mailing address:
  • Phone: 954-434-1705
  • Fax: 954-434-1882

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberME108751
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: