Basic Information
| Provider Information | |||||||||
| NPI: | 1275945172 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GUERRIER | ||||||||
| FirstName: | GUERSON | ||||||||
| MiddleName: | B | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4700 MILLENIA BLVD | ||||||||
| Address2: | |||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328396013 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4075336835 | ||||||||
| FaxNumber: | 4077700661 | ||||||||
| Practice Location | |||||||||
| Address1: | 7649 W COLONIAL DR STE 115 | ||||||||
| Address2: | |||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328187423 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4075222080 | ||||||||
| FaxNumber: | 8339630115 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/27/2014 | ||||||||
| LastUpdateDate: | 08/12/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/12/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 579 | FL | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | ACN579 | FL | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 018708 | PR | N | Allopathic & Osteopathic Physicians | Family Medicine | 208D00000X | 018708 | PR | N | Allopathic & Osteopathic Physicians | General Practice | 208D00000X | ACN579 | FL | Y | Allopathic & Osteopathic Physicians | General Practice |
ID Information
| ID | Type | State | Issuer | Description | O0472 | 01 | FL | MEDICARE | OTHER | 020755900 | 05 | FL | MEDICAID |