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General NPI Number Information
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NPI Number | 1457488231
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Entity Type | Organization
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Legal Business Name | PREMIER CARE PHYSICIAN
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Dates
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Enumeration Date | 02/27/2007
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Last Update Date | 09/23/2011
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Provider Practice Location Address
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Address Line | 820 E CARTWRIGHT RD STE 100
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City | MESQUITE
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State | TX
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Zip | 75149-6063
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Country | US
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Telephone | 214-320-7600
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Fax |
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Provider Business Mailing Address
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Address Line | 820 E CARTWRIGHT RD STE 100
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City | MESQUITE
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State | TX
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Zip | 75149-6063
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Country | US
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Telephone | 214-320-7600
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. FREDERICK GUTIERREZ TINIO
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Credential | M.D.
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Telephone | 214-320-7600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RA0000X
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Taxonomy Name | Adolescent Medicine (Internal Medicine) Physician
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License Number | N7885
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License Number State | TX
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