MEDICARE: MOTOG INC.

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
1	207R00000X	Internal Medicine Physician	35000	MO

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CO1315	OTHER	MO	MEDICARE RR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	2107378-003	OTHER	MO	CIGNA
3	100529	OTHER	MO	BCBS
4	617V4439	OTHER	MO	CMR
5	D04076	OTHER	MO	EXCLUSIVE CHOICCE
6	00001383	OTHER	MO	NHC HEALTH BENEFITS
7	2161557	OTHER	MO	AETNA
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
9	100380	OTHER	MO	HEALTHLINK
10	0400423	OTHER	MO	UHC

General Provider Information

NPI Number	:	1750564647
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOTOG INC.

Provider Business Mailing Address
First Line	:	3394 MCKELVEY RD STE 115
Second Line	:
City	:	BRIDGETON
State	:	MO
Zip	:	63044-2531
Country	:	US
Telephone Number	:	314-866-7116
Fax Number	:	314-380-0872

Provider Business Practice Location Address
First Line	:	3394 MCKELVEY RD STE 115
Second Line	:
City	:	BRIDGETON
State	:	MO
Zip	:	63044-2531
Country	:	US
Telephone Number	:	314-866-7116
Fax Number	:	314-380-0872

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	DR. ERNESTO GUTIERREZ
Credential	:	M.D.
Telephone Number	:	314-866-7116

Provider Enumeration Date	:	12/13/2007
Last Update Date	:	01/07/2026

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Directions to “MOTOG INC. ” Practice Location

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