1669672572 NPI number — DR. MARCO GUTIERREZ MD

Table of content: DR. MARCO GUTIERREZ MD (NPI 1669672572)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669672572 NPI number — DR. MARCO GUTIERREZ MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GUTIERREZ
Provider First Name:
MARCO
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1669672572
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/07/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5208 N 10TH ST # 239
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MCALLEN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78504-2701
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
956-683-8700
Provider Business Mailing Address Fax Number:
956-683-9440

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
401 S ALAMO RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALAMO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78516-2501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
956-787-9111
Provider Business Practice Location Address Fax Number:
956-683-9440
Provider Enumeration Date:
07/19/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  J4177 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 292450801 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8G6960 . This is a "BCBS OF TX" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 45D1003540 . This is a "CLIA # (ALAMO CLINIC)" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 137950513 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 45D1052653 . This is a "CLIA # (MCALLEN CLINIC)" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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