Provider Demographics
NPI:1235168014
Name:GUTIERREZ-VIZUET, OSCAR (MD)
Entity Type:Individual
Prefix:DR
First Name:OSCAR
Middle Name:
Last Name:GUTIERREZ-VIZUET
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 1:702 E CALTON RD
Mailing Address - Street 2:SUITE 201B
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041-3988
Mailing Address - Country:US
Mailing Address - Phone:956-725-6550
Mailing Address - Fax:
Practice Address - Street 1:702 E CALTON RD
Practice Address - Street 2:SUITE 201B
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-3988
Practice Address - Country:US
Practice Address - Phone:956-725-6550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-02
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH5743208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
00205HMedicare ID - Type Unspecified
E35089Medicare UPIN