Active NPI
Jack H Gutman, D.O.
- Sports Medicine (Family Medicine) Physician
- Anaheim, CA
National Provider Identifier
1578609160
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Sports Medicine (Family Medicine) Physician
- License
- 20A4188
- Practice address
- 6200 E Canyon Rim Rd
Ste 105B
Anaheim, CA 92807-4317 - Phone
- (714) 998-3627
- NPI assigned
- Jan 30, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Sports Medicine (Family Medicine) Physician | 207QS0010X | 20A4188 | CA | Primary |
Addresses
Primary practice location
6200 E Canyon Rim Rd
Ste 105B
Anaheim, CA 92807-4317
Mailing address
6200 E Canyon Rim Rd
Ste 105B
Anaheim, CA 92807-4317
Phone (714) 998-3627
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 Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4188 | CA | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170115200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1578609160",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6200 E CANYON RIM RD",
"address_2": "STE 105B",
"city": "ANAHEIM",
"state": "CA",
"postal_code": "928074317",
"telephone_number": "714-998-3627"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6200 E CANYON RIM RD",
"address_2": "STE 105B",
"city": "ANAHEIM",
"state": "CA",
"postal_code": "928074317",
"telephone_number": "714-998-3627"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GUTMAN",
"first_name": "JACK",
"middle_name": "H",
"credential": "D.O.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-01-30",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "207QS0010X",
"taxonomy_group": "",
"desc": "Family Medicine, Sports Medicine",
"state": "CA",
"license": "20A4188",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Anaheim, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.