Provider Demographics
NPI:1033472857
Name:GUZMAN, JOSE G (MD)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:G
Last Name:GUZMAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:203 RODENBACH LANE
Mailing Address - Street 2:RODENBACH LANE
Mailing Address - City:BRODHEADSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18322-9900
Mailing Address - Country:US
Mailing Address - Phone:570-992-4208
Mailing Address - Fax:570-992-6117
Practice Address - Street 1:801 OSTRUM ST
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18015-1000
Practice Address - Country:US
Practice Address - Phone:484-526-6048
Practice Address - Fax:484-526-6500
Is Sole Proprietor?:No
Enumeration Date:2012-06-18
Last Update Date:2015-11-17
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Provider Licenses
StateLicense IDTaxonomies
PAMD455290207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA003942OtherMEDICARE GROUP