Provider Demographics
NPI:1023379971
Name:GUTIERREZ M.D. P.L.L.C.
Entity Type:Organization
Organization Name:GUTIERREZ M.D. P.L.L.C.
Other - Org Name:SOUTH TEXAS URGENT CARE CENTER OF DEL RIO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAIME
Authorized Official - Middle Name:JAVIER
Authorized Official - Last Name:GUTIERREZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:830-775-1166
Mailing Address - Street 1:612 N BEDELL AVE SUITE A
Mailing Address - Street 2:
Mailing Address - City:DEL RIO
Mailing Address - State:TX
Mailing Address - Zip Code:78840-4173
Mailing Address - Country:US
Mailing Address - Phone:830-775-1166
Mailing Address - Fax:830-774-8551
Practice Address - Street 1:612 N BEDELL AVE SUITE A
Practice Address - Street 2:
Practice Address - City:DEL RIO
Practice Address - State:TX
Practice Address - Zip Code:78840-4173
Practice Address - Country:US
Practice Address - Phone:830-775-1166
Practice Address - Fax:830-774-8551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-06
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207Q00000X
TXJ9880261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX314709201Medicaid
TXTXB162015Medicare UPIN