=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750564647
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MOTOG INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/13/2007
-----------------------------------------------------
Last Update Date | 01/07/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3394 MCKELVEY RD STE 115
-----------------------------------------------------
City | BRIDGETON
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63044-2531
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-866-7116
-----------------------------------------------------
Fax | 314-380-0872
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3394 MCKELVEY RD STE 115
-----------------------------------------------------
City | BRIDGETON
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63044-2531
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-866-7116
-----------------------------------------------------
Fax | 314-380-0872
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PRESIDENT
-----------------------------------------------------
Name | DR. ERNESTO GUTIERREZ
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 314-866-7116
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | 35000
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------