Provider Demographics
NPI:1366475394
Name:GUTIERREZ, NOEL (MD)
Entity Type:Individual
Prefix:
First Name:NOEL
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 1:789 W 27TH ST STE 1
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-7207
Mailing Address - Country:US
Mailing Address - Phone:928-344-8400
Mailing Address - Fax:928-344-8412
Practice Address - Street 1:789 W 27TH ST STE 1
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-7207
Practice Address - Country:US
Practice Address - Phone:928-344-8400
Practice Address - Fax:928-344-8412
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2014-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301073797207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ240178Medicaid