Provider Demographics
NPI:1871575571
Name:GUETHON, JOSE ALBERTO (MD)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:ALBERTO
Last Name:GUETHON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:250 S AUSTRALIAN AVE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401-5018
Mailing Address - Country:US
Mailing Address - Phone:561-805-8500
Mailing Address - Fax:561-805-8501
Practice Address - Street 1:10413 SOUTHERN BLVD
Practice Address - Street 2:
Practice Address - City:ROYAL PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33411-4340
Practice Address - Country:US
Practice Address - Phone:561-793-1713
Practice Address - Fax:561-793-3242
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME56719207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
09865VMedicare ID - Type Unspecified
E73493Medicare UPIN