Basic Information
| Provider Information | |||||||||
| NPI: | 1750375291 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GUTHRIE | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | P | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1700 WOODLAWN AVE | ||||||||
| Address2: | |||||||||
| City: | DYERSBURG | ||||||||
| State: | TN | ||||||||
| PostalCode: | 38024 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7312874500 | ||||||||
| FaxNumber: | 7312874804 | ||||||||
| Practice Location | |||||||||
| Address1: | 1700 WOODLAWN AVE | ||||||||
| Address2: | |||||||||
| City: | DYERSBURG | ||||||||
| State: | TN | ||||||||
| PostalCode: | 38024 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7312874500 | ||||||||
| FaxNumber: | 7312874804 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/09/2005 | ||||||||
| LastUpdateDate: | 02/27/2008 | ||||||||
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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 | 207R00000X | MD019073 | TN | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0440228 | 01 | UNITED HEALTHCARE | OTHER | 3051685 | 05 | TN | MEDICAID | 0106846 | 01 | TN | BLUE CROSS | OTHER | 407113848 | 01 | PALMETTO GBA | OTHER | 116447 | 01 | BETTER HEALTH PLAN | OTHER | 7141 | 01 | TLC MEMPHIS MANAGED CARE | OTHER | 8005288 | 01 | CIGNA | OTHER | 5281070 | 01 | AETNA | OTHER |