Provider Demographics
NPI:1396006250
Name:GONZALEZ-FRAGA, JULIAN DAX (DO)
Entity Type:Individual
Prefix:
First Name:JULIAN
Middle Name:DAX
Last Name:GONZALEZ-FRAGA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 UNIVERSITY BLVD
Mailing Address - Street 2:
Mailing Address - City:GALVESTON
Mailing Address - State:TX
Mailing Address - Zip Code:77555-0566
Mailing Address - Country:US
Mailing Address - Phone:409-772-4182
Mailing Address - Fax:409-772-6507
Practice Address - Street 1:301 UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:GALVESTON
Practice Address - State:TX
Practice Address - Zip Code:77555-0566
Practice Address - Country:US
Practice Address - Phone:409-772-4182
Practice Address - Fax:409-772-6507
Is Sole Proprietor?:No
Enumeration Date:2012-06-06
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ3369207R00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine