Provider Demographics
NPI:1598767253
Name:GONZALEZ, JUAN M (MD)
Entity Type:Individual
Prefix:DR
First Name:JUAN
Middle Name:M
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:5618 YARWELL DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77096-3922
Mailing Address - Country:US
Mailing Address - Phone:713-723-2472
Mailing Address - Fax:
Practice Address - Street 1:1415 LA CONCHA LN
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-1801
Practice Address - Country:US
Practice Address - Phone:713-790-9080
Practice Address - Fax:713-790-1664
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXH4937207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8637K1OtherBLUE CROSS BLUE SHIELD
TXF67546Medicare UPIN
TX8637K1Medicare PIN