Provider Demographics
NPI:1558306563
Name:MARCO GUTIERREZ MD AND ASSOCIATES
Entity Type:Organization
Organization Name:MARCO GUTIERREZ MD AND ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARCO
Authorized Official - Middle Name:
Authorized Official - Last Name:GUTIERREZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-787-9111
Mailing Address - Street 1:5208 N 10TH ST # 239
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-2701
Mailing Address - Country:US
Mailing Address - Phone:956-787-9111
Mailing Address - Fax:956-683-9440
Practice Address - Street 1:401 S ALAMO RD
Practice Address - Street 2:
Practice Address - City:ALAMO
Practice Address - State:TX
Practice Address - Zip Code:78516
Practice Address - Country:US
Practice Address - Phone:956-787-9111
Practice Address - Fax:956-683-9440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-17
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ4177207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX45D1052653OtherCLIA # (MCALLEN CLINIC)
TX45D1003540OtherCLIA # (ALAMO CLINIC)
TX292450801Medicaid
TX080187673OtherRAILROAD MEDICARE
TX0076JFOtherBCBS OF TEXAS
TX137950513Medicaid
TX0076JFOtherBCBS OF TEXAS