Provider Demographics
NPI:1447373659
Name:DAVID M. GUTSTEIN, M.D.,P.A.
Entity type:Organization
Organization Name:DAVID M. GUTSTEIN, M.D.,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:M
Authorized Official - Last Name:GUTSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:239-466-8838
Mailing Address - Street 1:15621 NEW HAMPSHIRE CT
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33908-4123
Mailing Address - Country:US
Mailing Address - Phone:239-466-8838
Mailing Address - Fax:239-466-7669
Practice Address - Street 1:15621 NEW HAMPSHIRE CT
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-4123
Practice Address - Country:US
Practice Address - Phone:239-466-8838
Practice Address - Fax:239-466-7669
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2013-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME65573207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL376267000Medicaid
FLE15781Medicare UPIN
FLK3099Medicare PIN