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General NPI Number Information
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NPI Number | 1396998977
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Entity Type | Individual
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Provider Name | OMAR DE JESUS GUTIERREZ M.D.
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Gender | Male
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Dates
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Enumeration Date | 10/28/2008
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Last Update Date | 08/26/2025
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Provider Practice Location Address
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Address Line | 1635 MARVEL ST
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City | COUSHATTA
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State | LA
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Zip | 71019-9022
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Country | US
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Telephone | 318-932-2000
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Fax |
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Provider Business Mailing Address
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Address Line | 1635 MARVEL ST
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City | COUSHATTA
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State | LA
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Zip | 71019-9022
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Country | US
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Telephone | 318-932-2000
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | E-14401
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 250840
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 324278
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License Number State | LA
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Taxonomy #4
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 250840-1
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License Number State | NY
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