=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699748228
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JAIME MARIA GUERRERO MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/13/2006
-----------------------------------------------------
Last Update Date | 11/28/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 614 E CHESTNUT ST
-----------------------------------------------------
City | LOUISVILLE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40202-1604
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 502-589-0900
-----------------------------------------------------
Fax | 502-589-9928
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 302 STAG CIR
-----------------------------------------------------
City | SELLERSBURG
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47172-9774
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 502-640-0618
-----------------------------------------------------
Fax | 502-238-2889
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207L00000X
-----------------------------------------------------
Taxonomy Name | Anesthesiology Physician
-----------------------------------------------------
License Number | 01047755A
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207L00000X
-----------------------------------------------------
Taxonomy Name | Anesthesiology Physician
-----------------------------------------------------
License Number | 30735
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------