Provider Demographics
NPI:1326029869
Name:GONZALEZ, DAGOBERTO I JR (MD)
Entity Type:Individual
Prefix:DR
First Name:DAGOBERTO
Middle Name:I
Last Name:GONZALEZ
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7109 BARTLETT AVE SUTE 101
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041
Mailing Address - Country:US
Mailing Address - Phone:956-717-5775
Mailing Address - Fax:956-717-5875
Practice Address - Street 1:7109 BARTLETT AVE SUTE 101
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041
Practice Address - Country:US
Practice Address - Phone:956-717-5775
Practice Address - Fax:956-717-5875
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-10
Last Update Date:2019-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK3902207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1654683-01Medicaid
TX8M7440OtherBLUE CROSS BLUE SHIELD
TXI06709Medicare UPIN
TX1654683-01Medicaid