Provider Demographics
NPI:1558332791
Name:GUTIERREZ, ORESTES (DO)
Entity Type:Individual
Prefix:
First Name:ORESTES
Middle Name:
Last Name:GUTIERREZ
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 E 24TH AVE
Mailing Address - Street 2:SUITE #2
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97405-2907
Mailing Address - Country:US
Mailing Address - Phone:541-232-5627
Mailing Address - Fax:
Practice Address - Street 1:5 E 24TH AVENUE
Practice Address - Street 2:SUITE #2
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97405-2907
Practice Address - Country:US
Practice Address - Phone:541-232-5627
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-27
Last Update Date:2012-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDO152080207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine