Basic Information
| Provider Information | |||||||||
| NPI: | 1174825962 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GORDON P GUTHRIE, JR., M.D. PSC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1985 | ||||||||
| Address2: | |||||||||
| City: | LEXINGTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 405881985 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8592778179 | ||||||||
| FaxNumber: | 8592779320 | ||||||||
| Practice Location | |||||||||
| Address1: | 1780 NICHOLASVILLE ROAD | ||||||||
| Address2: | SUITE 602 | ||||||||
| City: | LEXINGTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 405031400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8592751943 | ||||||||
| FaxNumber: | 8592778999 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/30/2010 | ||||||||
| LastUpdateDate: | 02/10/2011 | ||||||||
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| AuthorizedOfficialLastName: | GUTHRIE | ||||||||
| AuthorizedOfficialFirstName: | GORDON | ||||||||
| AuthorizedOfficialMiddleName: | P | ||||||||
| AuthorizedOfficialTitleorPosition: | PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 8592751943 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNameSuffix: | JR. | ||||||||
| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RE0101X | 18859 | KY | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism |
ID Information
| ID | Type | State | Issuer | Description | 64188592 | 05 | KY | MEDICAID |