Provider Demographics
NPI:1538143300
Name:GUTIERREZ, JOSEPH M (MD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:M
Last Name:GUTIERREZ
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:PO BOX 55015
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85078-5015
Mailing Address - Country:US
Mailing Address - Phone:602-513-3616
Mailing Address - Fax:480-657-9265
Practice Address - Street 1:8022 N 27TH AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85051-6302
Practice Address - Country:US
Practice Address - Phone:602-513-3616
Practice Address - Fax:480-657-9265
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2018-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ32998207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ871089Medicaid
AZZ81864Medicare PIN
AZI09545Medicare UPIN