Provider Demographics
NPI:1407812852
Name:GONZALEZ, ROBERT MEDELL (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:MEDELL
Last Name:GONZALEZ
Suffix:
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 1:17460 IH 35 N
Mailing Address - Street 2:# 160-155
Mailing Address - City:SCHERTZ
Mailing Address - State:TX
Mailing Address - Zip Code:78154-1243
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:111 DALLAS ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78205-1201
Practice Address - Country:US
Practice Address - Phone:210-297-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2008-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK3206207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX031150804Medicaid
TX031150801Medicaid
TX031150805Medicaid
TX031150803Medicaid
TX031150806Medicaid
TX00797GMedicare ID - Type Unspecified
TX031150806Medicaid
8K3649Medicare PIN
TX031150804Medicaid
TX031150805Medicaid
8K3558Medicare PIN