Provider Demographics
NPI:1033195722
Name:DIAZ-GONZALEZ, ROBERTO (MD)
Entity Type:Individual
Prefix:
First Name:ROBERTO
Middle Name:
Last Name:DIAZ-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 1:191 EAST PRICE RD
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78521-2908
Mailing Address - Country:US
Mailing Address - Phone:956-548-7400
Mailing Address - Fax:956-621-3689
Practice Address - Street 1:191 EAST PRICE RD
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78523-2908
Practice Address - Country:US
Practice Address - Phone:956-548-7400
Practice Address - Fax:956-621-3689
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ4774207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX127026606Medicaid
TX742176836OtherEMPLOYER IDENTIFICATION NUMBER
TX86M879Medicare ID - Type Unspecified
TX742176836OtherEMPLOYER IDENTIFICATION NUMBER
TX671968Medicare Oscar/Certification
TXE04110Medicare UPIN