Provider Demographics
NPI:1942477039
Name:DENNIS R. GUTZMAN, MD PA
Entity Type:Organization
Organization Name:DENNIS R. GUTZMAN, MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:R
Authorized Official - Last Name:GUTZMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-616-0465
Mailing Address - Street 1:2424 BABCOCK RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-6031
Mailing Address - Country:US
Mailing Address - Phone:210-616-0462
Mailing Address - Fax:210-616-0467
Practice Address - Street 1:2424 BABCOCK RD
Practice Address - Street 2:SUITE 201
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-6031
Practice Address - Country:US
Practice Address - Phone:210-616-0462
Practice Address - Fax:210-616-0467
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-08
Last Update Date:2009-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE7102207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXDN4718OtherMEDICARE RAILROAD
TX1988453-01Medicaid
TX134168701Medicaid
TX134168701Medicaid
TXDN4718OtherMEDICARE RAILROAD