Provider Demographics
NPI:1588657035
Name:GONZALEZ, JAVIER ANTONIO (MD)
Entity Type:Individual
Prefix:
First Name:JAVIER
Middle Name:ANTONIO
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 1:1509 1ST ST
Mailing Address - Street 2:
Mailing Address - City:ROSENBERG
Mailing Address - State:TX
Mailing Address - Zip Code:77471-3305
Mailing Address - Country:US
Mailing Address - Phone:832-451-9290
Mailing Address - Fax:281-232-2361
Practice Address - Street 1:1509 1ST ST
Practice Address - Street 2:
Practice Address - City:ROSENBERG
Practice Address - State:TX
Practice Address - Zip Code:77471-3305
Practice Address - Country:US
Practice Address - Phone:832-451-9290
Practice Address - Fax:281-232-2361
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK0045208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXK0045OtherLICENSE NUMBER
TXK0045OtherLICENSE NUMBER