Provider Demographics
NPI:1811986946
Name:GUTIERREZ, MARY MARGARET (MD)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:MARGARET
Last Name:GUTIERREZ
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:504 PECAN BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78501-2345
Mailing Address - Country:US
Mailing Address - Phone:956-627-5747
Mailing Address - Fax:956-627-5761
Practice Address - Street 1:504 W PECAN BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78501
Practice Address - Country:US
Practice Address - Phone:956-627-5747
Practice Address - Fax:956-627-5761
Is Sole Proprietor?:No
Enumeration Date:2005-10-20
Last Update Date:2016-09-13
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Provider Licenses
StateLicense IDTaxonomies
MA55946208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3031543Medicaid
MA3031543Medicaid
MAE03150Medicare UPIN