MEDICARE: EZARA GUTIERREZ DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207QB0002X	Obesity Medicine (Family Medicine) Physician	S4483	TX
2	207QA0505X	Adult Medicine Physician	S4483	TX

General Provider Information

NPI Number	:	1942738240
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EZARA GUTIERREZ DO

Provider Business Mailing Address
First Line	:	6423 BABCOCK RD STE 101
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78249-2950
Country	:	US
Telephone Number	:	210-544-5715
Fax Number	:

Provider Business Practice Location Address
First Line	:	6423 BABCOCK RD STE 101
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78249-2950
Country	:	US
Telephone Number	:	210-544-5715
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/31/2017
Last Update Date	:	03/19/2024

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Directions to “ EZARA GUTIERREZ DO” Practice Location

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