Provider Demographics
NPI:1225302102
Name:GUTIERREZ MD PLLC
Entity Type:Organization
Organization Name:GUTIERREZ MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:MORGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:830-278-1166
Mailing Address - Street 1:3040 E MAIN ST
Mailing Address - Street 2:STE Z
Mailing Address - City:UVALDE
Mailing Address - State:TX
Mailing Address - Zip Code:78801-6424
Mailing Address - Country:US
Mailing Address - Phone:830-278-1166
Mailing Address - Fax:830-278-1223
Practice Address - Street 1:612 N BEDELL AVE
Practice Address - Street 2:STE A
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-24
Last Update Date:2012-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ9880207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty