Provider Demographics
NPI:1023083862
Name:GUTIERREZ-PERRY, LUIS (MD)
Entity type:Individual
Prefix:
First Name:LUIS
Middle Name:
Last Name:GUTIERREZ-PERRY
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 1:3406 BOB ROGERS DR.
Mailing Address - Street 2:SUITE 120
Mailing Address - City:EAGLE PASS
Mailing Address - State:TX
Mailing Address - Zip Code:78852-5942
Mailing Address - Country:US
Mailing Address - Phone:830-757-4913
Mailing Address - Fax:830-757-8708
Practice Address - Street 1:3406 BOB ROGERS DR.
Practice Address - Street 2:SUITE 120
Practice Address - City:EAGLE PASS
Practice Address - State:TX
Practice Address - Zip Code:78852-5942
Practice Address - Country:US
Practice Address - Phone:830-757-4913
Practice Address - Fax:830-757-8708
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2011-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG7818208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX114909801Medicaid
TXC35186Medicare UPIN
TX00JY58Medicare ID - Type Unspecified