MEDICARE: RICHARD GUTIERREZ CRNA

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	367500000X	Certified Registered Nurse Anesthetist	RN9233338	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00778588	OTHER		RAILROAD MEDICARE WITH GROUP CF4811

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	G000E	OTHER	FL	BCBS
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1740416056
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD GUTIERREZ CRNA

Provider Business Mailing Address
First Line	:	339 RANCH RD
Second Line	:
City	:	TARPON SPRINGS
State	:	FL
Zip	:	34688-9027
Country	:	US
Telephone Number	:	407-497-3394
Fax Number	:

Provider Business Practice Location Address
First Line	:	339 RANCH RD
Second Line	:
City	:	TARPON SPRINGS
State	:	FL
Zip	:	34688-9027
Country	:	US
Telephone Number	:	407-497-3394
Fax Number	:

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

Provider Enumeration Date	:	06/02/2009
Last Update Date	:	06/05/2016

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Directions to “ RICHARD GUTIERREZ CRNA” Practice Location

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