Healthcare Provider Details

I. General information

NPI: 1053307660
Provider Name (Legal Business Name): RAUL V GUERRERO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2005
Last Update Date: 03/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1614 E NORRIS DR
OTTAWA IL
61350-3681
US

IV. Provider business mailing address

1614 E NORRIS DR
OTTAWA IL
61350-3681
US

V. Phone/Fax

Practice location:
  • Phone: 815-433-1010
  • Fax: 815-433-0067
Mailing address:
  • Phone: 815-433-1010
  • Fax: 815-433-0067

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036079759
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: