Provider Demographics
NPI:1386628246
Name:BOX, GLORIA GONZALEZ (MD)
Entity Type:Individual
Prefix:
First Name:GLORIA
Middle Name:GONZALEZ
Last Name:BOX
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:PO BOX 587
Mailing Address - Street 2:
Mailing Address - City:GONZALES
Mailing Address - State:TX
Mailing Address - Zip Code:78629-0587
Mailing Address - Country:US
Mailing Address - Phone:830-672-8502
Mailing Address - Fax:830-672-3035
Practice Address - Street 1:1110 N. SARAH DEWITT DR
Practice Address - Street 2:
Practice Address - City:GONZALES
Practice Address - State:TX
Practice Address - Zip Code:78629-4112
Practice Address - Country:US
Practice Address - Phone:830-672-8502
Practice Address - Fax:830-672-3035
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-05
Last Update Date:2016-09-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXH9811207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX043630501Medicaid
TX043630501Medicaid
TX292466YP22Medicare Oscar/Certification