Healthcare Provider Details

I. General information

NPI: 1669552717
Provider Name (Legal Business Name): GARY JOSEPH GUZZARDO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 01/16/2020
Certification Date: 01/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3193 SE DIXIE HWY
STUART FL
34997-5072
US

IV. Provider business mailing address

3193 SE DIXIE HWY
STUART FL
34997-5072
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:
Title or Position:
Credential:
Phone: