Basic Information
| Provider Information | |||||||||
| NPI: | 1730447251 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GUTMAN | ||||||||
| FirstName: | STACEY | ||||||||
| MiddleName: | LYNN | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 800 ROSE STREET | ||||||||
| Address2: | |||||||||
| City: | LEXINGTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 40536 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8593236762 | ||||||||
| FaxNumber: | 7593236840 | ||||||||
| Practice Location | |||||||||
| Address1: | 181 FRANKLIN HEALTH COMMONS | ||||||||
| Address2: | |||||||||
| City: | FARMINGTON | ||||||||
| State: | ME | ||||||||
| PostalCode: | 04938 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2077786579 | ||||||||
| FaxNumber: | 2077786409 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/03/2012 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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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 | 208600000X | R2933 | KY | N | Allopathic & Osteopathic Physicians | Surgery | 208600000X | MD21753 | ME | Y | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.