Provider Demographics
NPI:1437688702
Name:GOUTHMAN, ROBERTO JR (DO)
Entity type:Individual
Prefix:DR
First Name:ROBERTO
Middle Name:
Last Name:GOUTHMAN
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:297 E HWY 50 STE 1
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-2500
Mailing Address - Country:US
Mailing Address - Phone:786-843-5463
Mailing Address - Fax:830-402-4521
Practice Address - Street 1:297 E HWY 50 STE 1
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-2500
Practice Address - Country:US
Practice Address - Phone:786-843-5463
Practice Address - Fax:830-402-4521
Is Sole Proprietor?:No
Enumeration Date:2017-06-08
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS168802084P0800X
390200000X
COTL00065382084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program