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General NPI Number Information
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NPI Number | 1619996741
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Entity Type | Individual
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Provider Name | CLYDE EARL GUTHROW, JR. M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/19/2006
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 1330 OAK LN SUITE 203
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City | LYNCHBURG
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State | VA
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Zip | 24503-2513
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Country | US
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Telephone | 434-947-5959
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Fax | 434-384-1293
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Provider Business Mailing Address
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Address Line | 1330 OAK LN SUITE 203
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City | LYNCHBURG
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State | VA
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Zip | 24503-2513
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Country | US
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Telephone | 434-947-5959
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Fax | 434-384-1293
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | 0101032458
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License Number State | VA
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