Provider Demographics
NPI:1598790644
Name:AILLON, GONZALO A II (DO)
Entity Type:Individual
Prefix:DR
First Name:GONZALO
Middle Name:A
Last Name:AILLON
Suffix:II
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 1:1138 BRADLEY DR
Mailing Address - Street 2:
Mailing Address - City:DUNCANVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75137-4224
Mailing Address - Country:US
Mailing Address - Phone:214-536-3355
Mailing Address - Fax:972-572-2258
Practice Address - Street 1:1401 S RANGERVILLE RD
Practice Address - Street 2:
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78552-7638
Practice Address - Country:US
Practice Address - Phone:956-430-2408
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2019-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL2781207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX158305602Medicaid
TX158305603Medicaid
TX158305602Medicaid