Provider Demographics
NPI:1316067200
Name:GUTIERREZ-DORRINGTON, JORGE H (MD)
Entity type:Individual
Prefix:DR
First Name:JORGE
Middle Name:H
Last Name:GUTIERREZ-DORRINGTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 801089
Mailing Address - Street 2:
Mailing Address - City:COTO LAUREL
Mailing Address - State:PR
Mailing Address - Zip Code:00780-1089
Mailing Address - Country:US
Mailing Address - Phone:787-842-2512
Mailing Address - Fax:787-840-6966
Practice Address - Street 1:613 AVE TITO CASTRO STE 101
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00716-0206
Practice Address - Country:US
Practice Address - Phone:787-842-2512
Practice Address - Fax:787-840-6966
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2019-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11622207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR90035Medicare ID - Type Unspecified
PRG61738Medicare UPIN