Individual provider Active NPI

John D. Guletz, MD

  • Gastroenterology Physician
  • Evansville, IN
National Provider Identifier
1407874159
Registry record updated Jul 11, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
License
01030324 Issued in IN
Practice address
801 Saint Marys Dr
Suite 205 W
Evansville, IN 47714-0518
Phone
(812) 477-6103
Fax
(812) 477-4897
NPI assigned
Jul 18, 2006
Last updated
Jul 11, 2008By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 11, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology Physician 207RG0100X 01030324 IN Primary

Addresses

Primary practice location

801 Saint Marys Dr
Suite 205 W
Evansville, IN 47714-0518

Mailing address

801 Saint Marys Dr
Suite 205 W
Evansville, IN 47714-0518
Phone (812) 477-6103

Other identifiers 1

IdentifierTypeStateIssuer
100246330AMedicaidIN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153180800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1215734400000",
    "number": "1407874159",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "801 SAINT MARYS DR",
            "address_2": "SUITE 205 W",
            "city": "EVANSVILLE",
            "state": "IN",
            "postal_code": "477140518",
            "telephone_number": "812-477-6103",
            "fax_number": "812-477-4897"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "801 SAINT MARYS DR",
            "address_2": "SUITE 205 W",
            "city": "EVANSVILLE",
            "state": "IN",
            "postal_code": "477140518",
            "telephone_number": "812-477-6103",
            "fax_number": "812-477-4897"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GULETZ",
        "first_name": "JOHN",
        "middle_name": "D.",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-18",
        "last_updated": "2008-07-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "IN",
            "license": "01030324",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100246330A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Evansville, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.