Provider Demographics
NPI:1114979572
Name:GONZALEZ, JOSE ENCARNACION (MD)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:ENCARNACION
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:11861 PHYSICIANS DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-6280
Mailing Address - Country:US
Mailing Address - Phone:915-790-5700
Mailing Address - Fax:915-521-7928
Practice Address - Street 1:11861 PHYSICIANS DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-6280
Practice Address - Country:US
Practice Address - Phone:915-790-5700
Practice Address - Fax:915-521-7928
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL2905207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX156195301Medicaid
TX8F8441OtherBCBS OF TEXAS
TX080191737OtherRAILROAD MEDICARE
TX8F8441OtherBCBS OF TEXAS
TXH59190Medicare UPIN