Healthcare Provider Details

I. General information

NPI: 1639337140
Provider Name (Legal Business Name): GARY J. GUZZARDO, MD, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2008
Last Update Date: 02/25/2026
Certification Date: 02/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 SE OCEAN BLVD STE 103
STUART FL
34996-3332
US

IV. Provider business mailing address

2100 SE OCEAN BLVD STE 103
STUART FL
34996-3332
US

V. Phone/Fax

Practice location:
  • Phone: 772-247-7856
  • Fax: 772-247-7854
Mailing address:
  • Phone: 772-247-7856
  • Fax: 772-247-7854

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberME54901
License Number StateFL

VIII. Authorized Official

Name: TYLER BERGER
Title or Position: OWNER
Credential:
Phone: 305-504-6797