Provider Demographics
NPI:1609846682
Name:GONZALEZ, PEDRO DANIEL (MD)
Entity Type:Individual
Prefix:
First Name:PEDRO
Middle Name:DANIEL
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 1:141 INDUSTRIAL AVE
Mailing Address - Street 2:
Mailing Address - City:AZLE
Mailing Address - State:TX
Mailing Address - Zip Code:76020-2901
Mailing Address - Country:US
Mailing Address - Phone:817-444-3231
Mailing Address - Fax:817-444-3234
Practice Address - Street 1:141 INDUSTRIAL AVE
Practice Address - Street 2:
Practice Address - City:AZLE
Practice Address - State:TX
Practice Address - Zip Code:76020-2901
Practice Address - Country:US
Practice Address - Phone:817-444-3231
Practice Address - Fax:817-444-3234
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK8628207QS1201X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QS1201XAllopathic & Osteopathic PhysiciansFamily MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX142726202Medicaid
TX142726201Medicaid
TX8L27366Medicare PIN
TX142726202Medicaid
TX8226K6Medicare ID - Type Unspecified