Provider Demographics
NPI:1245234889
Name:GONZALEZ, ANNELIESE O (MD)
Entity Type:Individual
Prefix:
First Name:ANNELIESE
Middle Name:O
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6410 FANNIN ST SUITE 830
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030
Mailing Address - Country:US
Mailing Address - Phone:713-325-7702
Mailing Address - Fax:713-704-4941
Practice Address - Street 1:6400 FENNIN STREET
Practice Address - Street 2:SUITE 2900
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030
Practice Address - Country:US
Practice Address - Phone:713-704-3961
Practice Address - Fax:713-704-4941
Is Sole Proprietor?:No
Enumeration Date:2005-06-10
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL9212174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX166693501Medicaid
TX88091XMedicare ID - Type Unspecified