Provider Demographics
NPI:1013184985
Name:GONZALEZ, STEVAN A (MD)
Entity Type:Individual
Prefix:
First Name:STEVAN
Middle Name:A
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1250 8TH AVE
Mailing Address - Street 2:SUITE 515
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-4124
Mailing Address - Country:US
Mailing Address - Phone:817-922-4675
Mailing Address - Fax:817-922-4645
Practice Address - Street 1:1250 8TH AVE
Practice Address - Street 2:SUITE 515
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-4124
Practice Address - Country:US
Practice Address - Phone:817-922-4675
Practice Address - Fax:817-922-4645
Is Sole Proprietor?:No
Enumeration Date:2008-05-10
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM9319207R00000X, 207RG0100X, 207RI0008X, 207RT0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RT0003XAllopathic & Osteopathic PhysiciansInternal MedicineTransplant Hepatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207RI0008XAllopathic & Osteopathic PhysiciansInternal MedicineHepatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX194435703Medicaid
TX194435701Medicaid
TX194435702Medicaid
TX8X0059OtherBCBS
TX8K8550Medicare PIN
TX8K8248Medicare PIN
TX8K8255Medicare PIN
TXP01032160Medicare PIN