Provider Demographics
NPI:1457457723
Name:GUTIERREZ, ALVARO R (MD)
Entity Type:Individual
Prefix:DR
First Name:ALVARO
Middle Name:R
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 1:2199 CHEAT RD
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26508-4451
Mailing Address - Country:US
Mailing Address - Phone:304-594-3258
Mailing Address - Fax:304-594-3498
Practice Address - Street 1:2199 CHEAT RD
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26508-4451
Practice Address - Country:US
Practice Address - Phone:304-594-3258
Practice Address - Fax:304-594-3498
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2011-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV140792084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0089848001Medicaid
WV0089848001Medicaid
WVE02505Medicare UPIN