Provider Demographics
NPI:1699748228
Name:GUERRERO, JAIME MARIA (MD)
Entity type:Individual
Prefix:
First Name:JAIME
Middle Name:MARIA
Last Name:GUERRERO
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 1:302 STAG CIR
Mailing Address - Street 2:
Mailing Address - City:SELLERSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:47172-9774
Mailing Address - Country:US
Mailing Address - Phone:502-640-0618
Mailing Address - Fax:502-238-2889
Practice Address - Street 1:614 E CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1604
Practice Address - Country:US
Practice Address - Phone:502-589-0900
Practice Address - Fax:502-589-9928
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01047755A207L00000X
KY30735207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000393692OtherANTHEM
KY00032001Medicare PIN
000000393692OtherANTHEM