Provider Demographics
NPI:1629016456
Name:GONZALEZ, LUIS ALFREDO (MD)
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:ALFREDO
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1821 SESAME DRIVE
Mailing Address - Street 2:SUITE#8
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78550
Mailing Address - Country:US
Mailing Address - Phone:956-425-6500
Mailing Address - Fax:956-425-6501
Practice Address - Street 1:1821 SESAME DRIVE
Practice Address - Street 2:SUITE#8
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550
Practice Address - Country:US
Practice Address - Phone:956-425-6500
Practice Address - Fax:956-425-6501
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2009-10-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXL0213207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX080186705OtherRAILROAD MEDICARE
TX8871B7OtherBLUE CROSS BLUE SHIELD
TX043219703Medicaid
TX8871B7OtherBLUE CROSS BLUE SHIELD
TX080186705OtherRAILROAD MEDICARE