Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 12011 | TX |
NPI | 1255676268 |
---|---|
Provider Name | Dr. Jose Mario Gutierrez III |
First Address | San Antonio, TX 78260-6287 |
Second Address | San Antonio, TX 78229-3901 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/12/2012 |
Last Update Date | 02/12/2012 |