Individual ProviderIvan Gutierrez DurruthyFamily MedicineAllopathic & Osteopathic PhysiciansPractice Address9309 N Florida Ave Ste 111, Tampa, FL 33612-7237(813) 444-9823PECOS EnrollmentBased on the most recent information from CMS, provider Ivan Gutierrez Durruthy is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records yesterday at 10:58 AM.Profile DetailsProvider ID1356915839Provider TypeIndividualFull NameGutierrez Durruthy, IvanCredentialMDGenderMaleSole ProprietorYesEnumeration Date5/18/2021Last Updated11/22/2023Contact InformationPractice LocationPractice Address9309 N Florida Ave Ste 111, Tampa, FL 33612-7237Phone(813) 444-9823FaxUnlisted FaxMailing LocationMailing Address9309 N Florida Ave Ste 111, Tampa, FL 33612-7237Phone(813) 444-9823FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode207Q00000XPrimaryDescriptionFamily MedicineAllopathic & Osteopathic PhysiciansLicenseACN1588FloridaCode207R00000XDescriptionInternal MedicineAllopathic & Osteopathic PhysiciansLicense16427-IPuerto RicoCode363A00000XDescriptionPhysician AssistantPhysician Assistants & Advanced Practice Nursing ProvidersLicense000964-PAPuerto Rico