Provider Demographics
NPI:1578572186
Name:GONZALEZ STAWINSKI, GONZALO V (MD)
Entity Type:Individual
Prefix:
First Name:GONZALO
Middle Name:V
Last Name:GONZALEZ STAWINSKI
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 1:3900 JUNIUS ST
Mailing Address - Street 2:SUITE #605
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75246-1615
Mailing Address - Country:US
Mailing Address - Phone:214-820-7100
Mailing Address - Fax:214-820-6863
Practice Address - Street 1:3900 JUNIUS ST
Practice Address - Street 2:SUITE #605
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-1615
Practice Address - Country:US
Practice Address - Phone:214-820-7100
Practice Address - Fax:214-820-6863
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35087946208G00000X
TXP2654208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2670006Medicaid
TX301794901Medicaid
TX298563YMNTMedicare PIN
TXTXB156873Medicare PIN
OHI57057Medicare UPIN
OHGO7357861Medicare ID - Type Unspecified
OH2670006Medicaid
TX298563YKTPMedicare PIN