Basic Information
| Provider Information | |||||||||
| NPI: | 1629057336 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GUTTLER | ||||||||
| FirstName: | SANFORD | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 249 | ||||||||
| Address2: | |||||||||
| City: | CONOVER | ||||||||
| State: | NC | ||||||||
| PostalCode: | 286130249 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8284659730 | ||||||||
| FaxNumber: | 8284659293 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 TRADE ST | ||||||||
| Address2: | |||||||||
| City: | GRANITE FALLS | ||||||||
| State: | NC | ||||||||
| PostalCode: | 286301525 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8283963136 | ||||||||
| FaxNumber: | 8283963105 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/11/2006 | ||||||||
| LastUpdateDate: | 02/25/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 173000000X | 23284 | NC | N | Other Service Providers | Legal Medicine | 207Q00000X | 7923284 | NC | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | AG8655815 | 01 | NC | DEA | OTHER | CN8132 | 01 | NC | MEDICARE RAILROAD | OTHER | 790148F | 05 | NC | MEDICAID |