Healthcare Provider Details

I. General information

NPI: 1750564647
Provider Name (Legal Business Name): MOTOG INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2007
Last Update Date: 01/07/2026
Certification Date: 01/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3394 MCKELVEY RD STE 115
BRIDGETON MO
63044-2531
US

IV. Provider business mailing address

3394 MCKELVEY RD STE 115
BRIDGETON MO
63044-2531
US

V. Phone/Fax

Practice location:
  • Phone: 314-866-7116
  • Fax: 314-380-0872
Mailing address:
  • Phone: 314-866-7116
  • Fax: 314-380-0872

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35000
License Number StateMO

VIII. Authorized Official

Name: DR. ERNESTO GUTIERREZ
Title or Position: OWNER/PRESIDENT
Credential: M.D.
Phone: 314-866-7116