Provider Demographics
NPI:1023046265
Name:GUTIERREZ, HORACIO (MD)
Entity Type:Individual
Prefix:
First Name:HORACIO
Middle Name:
Last Name:GUTIERREZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1380 TULIP ST
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-3157
Mailing Address - Country:US
Mailing Address - Phone:303-651-5160
Mailing Address - Fax:303-651-5173
Practice Address - Street 1:1380 TULIP ST
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-3157
Practice Address - Country:US
Practice Address - Phone:303-651-5160
Practice Address - Fax:303-651-5173
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2016-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO377982085R0202X
CODR.0037798174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO54136831Medicaid
COF2008OtherBCBS
COP00121931OtherRAILROAD MEDICARE
COH00305Medicare UPIN
COC525158Medicare PIN