Provider Demographics
NPI:1538179056
Name:GUTIERREZ, OTTO EUGENIO (DO)
Entity type:Individual
Prefix:
First Name:OTTO
Middle Name:EUGENIO
Last Name:GUTIERREZ
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 SAN PEDRO AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78205-1128
Mailing Address - Country:US
Mailing Address - Phone:210-225-0808
Mailing Address - Fax:210-225-0829
Practice Address - Street 1:206 SAN PEDRO AVE STE 100
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78205-1128
Practice Address - Country:US
Practice Address - Phone:210-225-0808
Practice Address - Fax:210-225-0829
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2025-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE9214207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXE9214OtherPHYSICIAN LICENSE NO
TX113908102Medicaid
TXA66DMedicare ID - Type Unspecified
TX113908102Medicaid