Provider Demographics
NPI:1528385689
Name:GUTIERREZ MD PLLC
Entity Type:Organization
Organization Name:GUTIERREZ MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JAIME
Authorized Official - Middle Name:JAVIER
Authorized Official - Last Name:GUTIERREZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:830-765-6622
Mailing Address - Street 1:100 ENCINO DR
Mailing Address - Street 2:
Mailing Address - City:DEL RIO
Mailing Address - State:TX
Mailing Address - Zip Code:78840-2240
Mailing Address - Country:US
Mailing Address - Phone:830-765-6622
Mailing Address - Fax:830-774-8551
Practice Address - Street 1:612 N BEDELL AVE STE A
Practice Address - Street 2:
Practice Address - City:DEL RIO
Practice Address - State:TX
Practice Address - Zip Code:78840-4173
Practice Address - Country:US
Practice Address - Phone:830-775-1166
Practice Address - Fax:830-774-8551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-29
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ9880208D00000X, 261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Single Specialty