Basic Information
| Provider Information | |||||||||
| NPI: | 1740279140 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GUTSTEIN | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15621 NEW HAMPSHIRE CT | ||||||||
| Address2: | |||||||||
| City: | FORT MYERS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 339084123 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2394668838 | ||||||||
| FaxNumber: | 2394667669 | ||||||||
| Practice Location | |||||||||
| Address1: | 15621 NEW HAMPSHIRE CT | ||||||||
| Address2: | |||||||||
| City: | FORT MYERS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 339084123 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2394668838 | ||||||||
| FaxNumber: | 2394667669 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/18/2005 | ||||||||
| LastUpdateDate: | 07/08/2016 | ||||||||
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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 | 207RG0100X | ME65573 | FL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
ID Information
| ID | Type | State | Issuer | Description | P00281527 | 01 | FL | RAILROAD MEDICARE PROVIDER NUMBER | OTHER |