Provider Demographics
NPI:1992790737
Name:GUTIERREZ, JON M (CRNA)
Entity type:Individual
Prefix:
First Name:JON
Middle Name:M
Last Name:GUTIERREZ
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:ANDREWS
Mailing Address - State:TX
Mailing Address - Zip Code:79714-3617
Mailing Address - Country:US
Mailing Address - Phone:432-464-2200
Mailing Address - Fax:432-464-2567
Practice Address - Street 1:720 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:ANDREWS
Practice Address - State:TX
Practice Address - Zip Code:79714-3617
Practice Address - Country:US
Practice Address - Phone:432-464-2483
Practice Address - Fax:432-464-2567
Is Sole Proprietor?:No
Enumeration Date:2005-09-19
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX621408367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX193544702Medicaid
TX193544701Medicaid
TX193544701Medicaid
NM430044918OtherRAILROAD MEDICARE IND
NMNM016155OtherBCBS NM
NM000S9346Medicaid