Provider Demographics
NPI:1437114659
Name:FIERRO-CARRION, GUSTAVO A (MD)
Entity Type:Individual
Prefix:DR
First Name:GUSTAVO
Middle Name:A
Last Name:FIERRO-CARRION
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 1:5101 N A ST
Mailing Address - Street 2:# 237
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79705-2103
Mailing Address - Country:US
Mailing Address - Phone:432-686-9805
Mailing Address - Fax:
Practice Address - Street 1:5101 N A ST
Practice Address - Street 2:# 237
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79705-2103
Practice Address - Country:US
Practice Address - Phone:432-686-9805
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ4110207R00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX138467914Medicaid
TX8K8889OtherBCBS
TX138467914Medicaid
TX8B5821Medicare ID - Type Unspecified