Provider Demographics
NPI:1851395750
Name:GUTIERREZ, AMY JEAN (MD)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:JEAN
Last Name:GUTIERREZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 680186
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78268-0186
Mailing Address - Country:US
Mailing Address - Phone:210-798-9355
Mailing Address - Fax:210-798-9356
Practice Address - Street 1:9355 BANDERA RD
Practice Address - Street 2:STE 136
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78250-2566
Practice Address - Country:US
Practice Address - Phone:210-798-9355
Practice Address - Fax:210-798-9356
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXL6410207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXH90050Medicare UPIN
8A9459Medicare ID - Type Unspecified