Provider Demographics
NPI:1275556219
Name:GONZALEZ, ASHLEY M (MD)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:M
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:MICHELLE
Other - Last Name:BOURGEOIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1600 W 38TH ST STE 100
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-6404
Mailing Address - Country:US
Mailing Address - Phone:512-458-5323
Mailing Address - Fax:512-458-2030
Practice Address - Street 1:1600 W 38TH ST STE 100
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-6404
Practice Address - Country:US
Practice Address - Phone:512-458-5323
Practice Address - Fax:512-458-2030
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME95658208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL275249200Medicaid