Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | DEN-10003 | CO |
N | 1223G0001X | General Practice | DEN-10003 | CO |
N | 213EG0000X | General Practice | DEN-10003 | CO |
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 10643 | TN |
N | 1223S0112X | Oral and Maxillofacial Surgeon | DEN-10003 | CO |
NPI | 1023240009 |
---|---|
Provider Name | Dr. Andrew Archibal Gutierrez |
First Address | Fort Campbell, KY 42223 |
Second Address | Fort Campbell, KY 42223-5582 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2009 |
Last Update Date | 16/06/2020 |