Healthcare Provider Details

I. General information

NPI: 1386630473
Provider Name (Legal Business Name): JOHN S GUTTELL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2005
Last Update Date: 08/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 PEARL ST SUITE 1000
BROCKTON MA
02301-2864
US

IV. Provider business mailing address

1 PEARL ST SUITE 1000
BROCKTON MA
02301-2864
US

V. Phone/Fax

Practice location:
  • Phone: 508-897-6070
  • Fax: 508-897-6075
Mailing address:
  • Phone: 508-897-6070
  • Fax: 508-897-6073

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number41880
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: