Basic Information
| Provider Information | |||||||||
| NPI: | 1508825779 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GUERRIER | ||||||||
| FirstName: | MARIE | ||||||||
| MiddleName: | KETTLY | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3441 SE WILLOUGHBY BLVD | ||||||||
| Address2: | |||||||||
| City: | STUART | ||||||||
| State: | FL | ||||||||
| PostalCode: | 349945060 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7722214030 | ||||||||
| FaxNumber: | 7722214041 | ||||||||
| Practice Location | |||||||||
| Address1: | 3441 SE WILLOUGHBY BLVD | ||||||||
| Address2: | |||||||||
| City: | STUART | ||||||||
| State: | FL | ||||||||
| PostalCode: | 349945060 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7722214030 | ||||||||
| FaxNumber: | 7722214041 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/17/2006 | ||||||||
| LastUpdateDate: | 12/28/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | ME67145 | FL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 31628 | 01 | FL | BCBS PROVIDER # | OTHER |