Provider Demographics
NPI:1598790933
Name:GUTIERREZ, JOSE A (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:A
Last Name:GUTIERREZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:7500 BEECHNUT
Mailing Address - Street 2:SUITE 214
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77074
Mailing Address - Country:US
Mailing Address - Phone:713-772-6519
Mailing Address - Fax:713-271-9943
Practice Address - Street 1:7500 BEECHNUT
Practice Address - Street 2:SUITE 214
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074
Practice Address - Country:US
Practice Address - Phone:713-772-6519
Practice Address - Fax:713-271-9943
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2013-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE50972084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
826263462OtherRAILROAD MEDICARE
TX115205002Medicaid
10015619OtherAMERIGROUP
TXTXB148056OtherMEDICARE PTAN
TX1346275229OtherBCBS