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NPI Code Detail

MEDICARE: DR. RODOLFO GABRIEL GUTIERREZ-MACIAS M.D.

MEDICARE: DR. RODOLFO GABRIEL GUTIERREZ-MACIAS M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine PhysicianP6174TX
2207Q00000XFamily Medicine PhysicianMD2004-0738NM

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1417952003
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. RODOLFO GABRIEL GUTIERREZ-MACIAS M.D.
Provider Business Mailing Address
First Line : 205 E UNIVERSITY AVE
Second Line : SUITE 200
City : GEORGETOWN
State : TX
Zip : 78626-6814
Country : US
Telephone Number : 877-800-5722
Fax Number :
Provider Business Practice Location Address
First Line : 305 MALLARD LN
Second Line :
City : TAYLOR
State : TX
Zip : 76574-1208
Country : US
Telephone Number : 877-800-5722
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/20/2005
Last Update Date : 04/17/2014

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