Provider Demographics
NPI:1942505698
Name:EMILIO GUTIERREZ JR MD PA
Entity type:Organization
Organization Name:EMILIO GUTIERREZ JR MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EMILIO
Authorized Official - Middle Name:
Authorized Official - Last Name:GUTIERREZ
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:512-474-9000
Mailing Address - Street 1:4400 RED RIVER ST
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78751-4010
Mailing Address - Country:US
Mailing Address - Phone:512-474-9000
Mailing Address - Fax:512-451-0819
Practice Address - Street 1:4400 RED RIVER ST
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78751-4010
Practice Address - Country:US
Practice Address - Phone:512-474-9000
Practice Address - Fax:512-451-0819
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-11
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH-4371207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00242JMedicare UPIN