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1790042513

NPI Code Detail

MEDICARE: DR. EDDY JOSE GUTIERREZ MD

MEDICARE: DR. EDDY JOSE GUTIERREZ MD

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	207R00000X	Internal Medicine Physician	84110	GA
2	207R00000X	Internal Medicine Physician	ME132154	FL
3	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	84110	GA
4	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	ME132154	FL

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1790042513
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDDY JOSE GUTIERREZ MD

Provider Business Mailing Address
First Line	:	1443 SAN MARCO BLVD STE 101
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32207-8535
Country	:	US
Telephone Number	:	904-253-6910
Fax Number	:	904-253-6964

Provider Business Practice Location Address
First Line	:	1443 SAN MARCO BLVD STE 101
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32207-8535
Country	:	US
Telephone Number	:	904-253-6910
Fax Number	:	904-253-6964

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

Provider Enumeration Date	:	04/18/2012
Last Update Date	:	08/20/2025

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Directions to “ DR. EDDY JOSE GUTIERREZ MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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