Provider Demographics
NPI:1730189275
Name:GUTIERREZ, FABIO ECHEVERRI (MD)
Entity type:Individual
Prefix:DR
First Name:FABIO
Middle Name:ECHEVERRI
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 36559
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23235-8011
Mailing Address - Country:US
Mailing Address - Phone:804-897-4250
Mailing Address - Fax:804-897-0670
Practice Address - Street 1:7101 JAHNKE RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23225-4017
Practice Address - Country:US
Practice Address - Phone:804-323-8820
Practice Address - Fax:804-323-8539
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-27
Last Update Date:2009-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101021805174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006603866Medicaid
220024672OtherRAILROAD MEDICARE
VA224094OtherANTHEM-JAHNKE RD.
27825OtherOPTIMAHEALTH
VA220000646Medicare ID - Type Unspecified
VA224094OtherANTHEM-JAHNKE RD.