Provider Demographics
NPI:1417195033
Name:MIGUEL ANGEL GUTIERREZ MD & ASSOCIATES
Entity Type:Organization
Organization Name:MIGUEL ANGEL GUTIERREZ MD & ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D./OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MIGUEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:GUTIERREZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-686-8100
Mailing Address - Street 1:2108 S M ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78503-1555
Mailing Address - Country:US
Mailing Address - Phone:956-686-8100
Mailing Address - Fax:956-686-8999
Practice Address - Street 1:2108 S M ST
Practice Address - Street 2:SUITE 4
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78503-1555
Practice Address - Country:US
Practice Address - Phone:956-686-8100
Practice Address - Fax:956-686-8999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-04
Last Update Date:2014-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK8190174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1922005438OtherNPI - INDIVIDUAL
TX090009401Medicaid
TX090009401Medicaid