1831191725 NPI number — DR. ERNESTO GUTIERREZ M.D.

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831191725 NPI number — DR. ERNESTO GUTIERREZ M.D.

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

GUTIERREZ

Provider First Name:

ERNESTO

Provider Middle Name:

Provider Name Prefix Text:

DR.

Provider Name Suffix Text:

Provider Credential Text:

M.D.

Provider Gender Code:

M

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:

1831191725

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

06/16/2023

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

1224 GRAHAM RD

Provider Second Line Business Mailing Address:

STE 1111

Provider Business Mailing Address City Name:

FLORISSANT

Provider Business Mailing Address State Name:

MO

Provider Business Mailing Address Postal Code:

63031-8028

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

314-837-3720

Provider Business Mailing Address Fax Number:

314-837-3983

Provider First Line Business Practice Location Address:

4100 UNION BLVD STE B

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

SAINT LOUIS

Provider Business Practice Location Address State Name:

MO

Provider Business Practice Location Address Postal Code:

63115-1225

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

314-531-1112

Provider Business Practice Location Address Fax Number:

314-209-2700

Provider Enumeration Date:

08/11/2005

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207R00000X , with the licence number:  35000 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 00001383 . This is a "NHC HEALTH BENEFIT PLAN" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
• Identifier: 100529 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
• Identifier: 2107378-003 . This is a "CIGNA" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
• Identifier: 2161557 . This is a "AETNA" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
• Identifier: 0400423 . This is a "UHC" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
• Identifier: 1636V18816 . This is a "HCUSA" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
• Identifier: D04076 . This is a "EXCLUSIVE CHOICE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
• Identifier: 100380 . This is a "HEALTHLINK" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
• Identifier: 617V4439 . This is a "GHP" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
• Identifier: 110045661 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
• Identifier: 617V4439 . This is a "CMR" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".