Provider Demographics
NPI:1992941975
Name:GURTMAN, FRED S (MD)
Entity type:Individual
Prefix:
First Name:FRED
Middle Name:S
Last Name:GURTMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1450 6TH ST SE
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33880-4505
Mailing Address - Country:US
Mailing Address - Phone:855-353-7546
Mailing Address - Fax:863-294-2767
Practice Address - Street 1:609 INDIAN ROCKS RD
Practice Address - Street 2:
Practice Address - City:BELLEAIR
Practice Address - State:FL
Practice Address - Zip Code:33756
Practice Address - Country:US
Practice Address - Phone:855-353-7546
Practice Address - Fax:727-315-0911
Is Sole Proprietor?:No
Enumeration Date:2008-12-23
Last Update Date:2019-07-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME43623207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
62504YMedicare PIN