Provider Demographics
NPI:1164418711
Name:GONZALEZ, MARK S (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:S
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4449
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78502-4449
Mailing Address - Country:US
Mailing Address - Phone:956-362-2171
Mailing Address - Fax:956-661-2204
Practice Address - Street 1:100 E RIDGE RD
Practice Address - Street 2:SUITE #A
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78503-1345
Practice Address - Country:US
Practice Address - Phone:956-682-1888
Practice Address - Fax:956-661-2204
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2017-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH0391207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX143824402Medicaid
TX143824403Medicaid
TX143824403Medicaid
TX143824403Medicaid