Provider Demographics
NPI:1114908803
Name:OBSTETRICS AND GYNECOLOGY ASSOCIATES OF LAREDO, P.A.
Entity Type:Organization
Organization Name:OBSTETRICS AND GYNECOLOGY ASSOCIATES OF LAREDO, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAGOBERTO
Authorized Official - Middle Name:I
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:956-717-5775
Mailing Address - Street 1:7109 NORTH BARTLETT AVE SUTE 101
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041-6473
Mailing Address - Country:US
Mailing Address - Phone:956-717-5775
Mailing Address - Fax:956-717-5875
Practice Address - Street 1:7109 NORTH BARTLETT AVE SUTE 101
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-6473
Practice Address - Country:US
Practice Address - Phone:956-717-5775
Practice Address - Fax:956-717-5875
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-09
Last Update Date:2019-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1654675-01Medicaid
TX0016LMOtherBLUE CROSS BLUE SHIELD
TX0016LMOtherBLUE CROSS BLUE SHIELD