Provider Demographics
NPI:1891703260
Name:GUTIERREZ, JOSE A JR (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:A
Last Name:GUTIERREZ
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:1515 PAPPAS ST
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041-1705
Mailing Address - Country:US
Mailing Address - Phone:956-795-8100
Mailing Address - Fax:956-718-6294
Practice Address - Street 1:473 STATE HIGHWAY 285
Practice Address - Street 2:
Practice Address - City:HEBBRONVILLE
Practice Address - State:TX
Practice Address - Zip Code:78361-4430
Practice Address - Country:US
Practice Address - Phone:956-795-8100
Practice Address - Fax:956-718-6294
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2015-08-10
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Provider Licenses
StateLicense IDTaxonomies
TXE7966207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX100233904Medicaid
TX100233904Medicaid