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General NPI Number Information
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NPI Number | 1609872118
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Entity Type | Individual
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Provider Name | ALBERT RICHARD GUTIERREZ JR. MD
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Gender | Male
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Dates
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Enumeration Date | 06/21/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 12037 CORTEZ BLVD
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City | BROOKSVILLE
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State | FL
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Zip | 34613-7349
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Country | US
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Telephone | 352-597-9008
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Fax | 352-597-1008
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Provider Business Mailing Address
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Address Line | 122 LINSLEY AVE STE A
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City | BRANDON
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State | FL
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Zip | 33511-5121
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Country | US
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Telephone | 813-657-4914
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Fax | 813-657-4916
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | ME43083
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License Number State | FL
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