MEDICARE: DR. JENNIFER LEE GUTHRIE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician	ME125307	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1821505215	OTHER		NPPES
2	ME125307	OTHER	FL	FL LICENSE

General Provider Information

NPI Number	:	1598081416
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JENNIFER LEE GUTHRIE M.D.

Provider Business Mailing Address
First Line	:	224 DATURA ST STE 315
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33401-5631
Country	:	US
Telephone Number	:	561-214-3323
Fax Number	:	561-828-6247

Provider Business Practice Location Address
First Line	:	224 DATURA ST STE 315
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33401-5631
Country	:	US
Telephone Number	:	561-214-3323
Fax Number	:	561-828-6247

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/16/2010
Last Update Date	:	02/08/2018

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