MEDICARE: DR. ERNESTO GUTIERREZ 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
1	207R00000X	Internal Medicine Physician	35000	MO

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
10	110045661	OTHER	MO	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00001383	OTHER	MO	NHC HEALTH BENEFIT PLAN
2	100529	OTHER	MO	BLUE CROSS BLUE SHIELD
3	2107378-003	OTHER	MO	CIGNA
4	2161557	OTHER	MO	AETNA
5	0400423	OTHER	MO	UHC
6	1636V18816	OTHER	MO	HCUSA
7	D04076	OTHER	MO	EXCLUSIVE CHOICE
8	100380	OTHER	MO	HEALTHLINK
9	617V4439	OTHER	MO	GHP
11	617V4439	OTHER	MO	CMR

General Provider Information

NPI Number	:	1831191725
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ERNESTO GUTIERREZ M.D.

Provider Business Mailing Address
First Line	:	1224 GRAHAM RD
Second Line	:	STE 1111
City	:	FLORISSANT
State	:	MO
Zip	:	63031-8028
Country	:	US
Telephone Number	:	314-837-3720
Fax Number	:	314-837-3983

Provider Business Practice Location Address
First Line	:	4100 UNION BLVD STE B
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63115-1225
Country	:	US
Telephone Number	:	314-531-1112
Fax Number	:	314-209-2700

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

Provider Enumeration Date	:	08/11/2005
Last Update Date	:	06/16/2023

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