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General NPI Number Information
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NPI Number | 1831191725
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Entity Type | Individual
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Provider Name | ERNESTO GUTIERREZ M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/11/2005
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Last Update Date | 06/16/2023
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Provider Practice Location Address
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Address Line | 4100 UNION BLVD STE B
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City | SAINT LOUIS
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State | MO
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Zip | 63115-1225
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Country | US
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Telephone | 314-531-1112
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Fax | 314-209-2700
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Provider Business Mailing Address
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Address Line | 1224 GRAHAM RD STE 1111
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City | FLORISSANT
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State | MO
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Zip | 63031-8028
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Country | US
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Telephone | 314-837-3720
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Fax | 314-837-3983
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 35000
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License Number State | MO
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