Provider Demographics
NPI:1760361828
Name:GUT PROFESSOR, LLC
Entity type:Organization
Organization Name:GUT PROFESSOR, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:DARLA
Authorized Official - Middle Name:
Authorized Official - Last Name:O'DWYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:936-234-4078
Mailing Address - Street 1:86 SHORELINE DR
Mailing Address - Street 2:
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75964-9000
Mailing Address - Country:US
Mailing Address - Phone:936-234-4078
Mailing Address - Fax:
Practice Address - Street 1:86 SHORELINE DR
Practice Address - Street 2:
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75964-9000
Practice Address - Country:US
Practice Address - Phone:936-552-9901
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-01
Last Update Date:2025-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty