MEDICARE: DR. KARL R GUTIERREZ MD

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	174400000X	Specialist	79-171	NM

Other Identifiers

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

General Provider Information

NPI Number	:	1790758571
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KARL R GUTIERREZ MD

Provider Business Mailing Address
First Line	:	1010 E ROOSEVELT AVE
Second Line	:
City	:	GRANTS
State	:	NM
Zip	:	87020-2118
Country	:	US
Telephone Number	:	505-287-2948
Fax Number	:	505-287-5372

Provider Business Practice Location Address
First Line	:	1010 E ROOSEVELT AVE
Second Line	:
City	:	GRANTS
State	:	NM
Zip	:	87020-2118
Country	:	US
Telephone Number	:	505-287-2948
Fax Number	:	505-287-5372

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/10/2006
Last Update Date	:	07/09/2007

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