Provider Demographics
NPI:1457463119
Name:GUTIERREZ, JULIAN (MD)
Entity Type:Individual
Prefix:DR
First Name:JULIAN
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 1:307 S FRONT ST
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17104-1621
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:111 S FRONT ST
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17101-2010
Practice Address - Country:US
Practice Address - Phone:717-782-3380
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2015-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD-047667-L207Q00000X
PAMD047667L207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA35109OtherGEISINGER
PA0017125410006Medicaid
PA50010096OtherCAPITAL BCBS
PA000074630OtherHIGHMARK BS
PA0017125410005Medicaid
PA141949OtherUNISON
PA1514915OtherGATEWAY
PA20023690OtherAMERIHEALTH
PA30024875OtherKEYSTONE MERCY
PA074630RQJMedicare PIN
PAF37080Medicare UPIN
PA1514915OtherGATEWAY