Provider Demographics
NPI:1235364365
Name:GONZALEZ, JUAN NETZAHUALCOYOTL (DPM)
Entity Type:Individual
Prefix:DR
First Name:JUAN
Middle Name:NETZAHUALCOYOTL
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5263 RUSTIC MANOR DR
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78526-3908
Mailing Address - Country:US
Mailing Address - Phone:956-455-7091
Mailing Address - Fax:
Practice Address - Street 1:713 N WARE RD
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78501-6616
Practice Address - Country:US
Practice Address - Phone:956-682-8496
Practice Address - Fax:956-682-0590
Is Sole Proprietor?:No
Enumeration Date:2009-05-19
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1893213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery