Healthcare Provider Details

I. General information

NPI: 1982876553
Provider Name (Legal Business Name): JAIME GABRIEL GUTIERREZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2008
Last Update Date: 04/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2309 ARTHUR AVE
BRONX NY
10458-8103
US

IV. Provider business mailing address

2309 ARTHUR AVE
BRONX NY
10458-8103
US

V. Phone/Fax

Practice location:
  • Phone: 347-284-4500
  • Fax: 347-284-4982
Mailing address:
  • Phone: 347-284-4500
  • Fax: 347-284-4982

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2082S0105X
TaxonomySurgery of the Hand (Plastic Surgery) Physician
License NumberME98062
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2082S0099X
TaxonomyPlastic Surgery Within the Head and Neck (Plastic Surgery) Physician
License NumberME98062
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberME98062
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number259768
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: