Provider Demographics
NPI:1669672572
Name:GUTIERREZ, MARCO (MD)
Entity Type:Individual
Prefix:DR
First Name:MARCO
Middle Name:
Last Name:GUTIERREZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:956-683-8700
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:78516-2501
Practice Address - Country:US
Practice Address - Phone:956-787-9111
Practice Address - Fax:956-683-9440
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-19
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ4177207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX292450801Medicaid
TX8G6960OtherBCBS OF TX
TX45D1003540OtherCLIA # (ALAMO CLINIC)
TX137950513Medicaid
TX45D1052653OtherCLIA # (MCALLEN CLINIC)
TX137950513Medicaid
TXF62479Medicare UPIN