Provider Demographics
NPI:1457488231
Name:PREMIER CARE PHYSICIAN
Entity Type:Organization
Organization Name:PREMIER CARE PHYSICIAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:GUTIERREZ
Authorized Official - Last Name:TINIO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-320-7600
Mailing Address - Street 1:820 E CARTWRIGHT RD STE 100
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75149-6063
Mailing Address - Country:US
Mailing Address - Phone:214-320-7600
Mailing Address - Fax:
Practice Address - Street 1:820 E CARTWRIGHT RD STE 100
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75149-6063
Practice Address - Country:US
Practice Address - Phone:214-320-7600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN7885207RA0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RA0000XAllopathic & Osteopathic PhysiciansInternal MedicineAdolescent MedicineGroup - Single Specialty