Provider Demographics
NPI:1972708154
Name:GUTTMAN, MARC JOEL (DO)
Entity type:Individual
Prefix:DR
First Name:MARC
Middle Name:JOEL
Last Name:GUTTMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2234 COLONIAL BLVD
Mailing Address - Street 2:ATTN: MANAGED CARE DEPT.
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1412
Mailing Address - Country:US
Mailing Address - Phone:239-931-7342
Mailing Address - Fax:239-931-7385
Practice Address - Street 1:8625 COLLIER BLVD
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34114-3550
Practice Address - Country:US
Practice Address - Phone:239-434-8565
Practice Address - Fax:239-434-8569
Is Sole Proprietor?:No
Enumeration Date:2007-06-18
Last Update Date:2016-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLOS11355208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL14E5POtherBCBS FL
FL346329OtherAVMED
FL46196OtherUNIVERSAL HEALTHCARE
FL003701500Medicaid
FL1193091OtherWELLCARE
FLP00956371OtherRAILROAD MEDICARE
FL7156430OtherCIGNA
FL9454740OtherAETNA
FLP994084OtherFREEDOM
FL3328120OtherUNITED HEALTHCARE
FLP959369OtherOPTIMUM
FL1193091OtherWELLCARE