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Individual

RENE S GUTIERREZ

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
3400 E MARKET ST, LOGANSPORT, IN 46947-2295
(574) 722-9633
(574) 722-5987
Mailing address
3400 E MARKET ST, LOGANSPORT, IN 46947-2295
(574) 722-9633
(574) 722-5987

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01042516
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000799590
ANTHEM
IN
05
200010560
IN
01
P01167875
RR MEDICARE
IN
Enumeration date
06/20/2005
Last updated
02/05/2016
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