Provider Demographics
NPI:1407951304
Name:GUTIERREZ, ENRIQUE G (MD)
Entity Type:Individual
Prefix:DR
First Name:ENRIQUE
Middle Name:G
Last Name:GUTIERREZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ENRIQUE
Other - Middle Name:G
Other - Last Name:GUTIERREZ-PEREZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:907 N CENTRAL AVE
Mailing Address - Street 2:STE A
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-5002
Mailing Address - Country:US
Mailing Address - Phone:407-891-1931
Mailing Address - Fax:407-891-1931
Practice Address - Street 1:907 N CENTRAL AVE STE A
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-5002
Practice Address - Country:US
Practice Address - Phone:407-846-2050
Practice Address - Fax:407-846-0338
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2016-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME45805207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL37819Medicare PIN
F72066Medicare UPIN