Provider Demographics
NPI:1023057528
Name:GUTIERREZ, BEVERLY SPAULDING (MD)
Entity type:Individual
Prefix:
First Name:BEVERLY
Middle Name:SPAULDING
Last Name:GUTIERREZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 HUNTERS GLN
Mailing Address - Street 2:
Mailing Address - City:FLORESVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78114-4213
Mailing Address - Country:US
Mailing Address - Phone:210-886-8031
Mailing Address - Fax:210-886-8059
Practice Address - Street 1:1010 NW LOOP 410 STE 100A
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78213-2220
Practice Address - Country:US
Practice Address - Phone:210-886-8031
Practice Address - Fax:210-886-8059
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2019-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG78912083X0100X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXG7891OtherTX LICENSE NUMBER
TX137985117Medicaid
TXG7891OtherTX LICENSE NUMBER
TX137985115Medicaid
TXTXB104005Medicare PIN
TX8L19952Medicare PIN
TX8CD277OtherBLUECROSS BLUESHIELD