Provider Demographics
NPI:1073781142
Name:GONZALEZ, ANTONIO VICTOR PRUDENTE (MD)
Entity Type:Individual
Prefix:
First Name:ANTONIO VICTOR
Middle Name:PRUDENTE
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4461 COIT RD
Mailing Address - Street 2:STE 409
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75035-0526
Mailing Address - Country:US
Mailing Address - Phone:214-396-8877
Mailing Address - Fax:214-983-0983
Practice Address - Street 1:7605 FOREST AVE
Practice Address - Street 2:SUITE 410
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23229-4938
Practice Address - Country:US
Practice Address - Phone:804-285-1833
Practice Address - Fax:804-285-5754
Is Sole Proprietor?:No
Enumeration Date:2008-02-12
Last Update Date:2021-08-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXT2172207RI0200X
VA0101242453207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC06304Medicare PIN