Provider Demographics
NPI:1659399087
Name:GONZALEZ, RUTH E (MD)
Entity Type:Individual
Prefix:MRS
First Name:RUTH
Middle Name:E
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2611 HARRISON
Mailing Address - Street 2:STE 900
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76308
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4531 MAPLEWOOD AVE
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76308-4609
Practice Address - Country:US
Practice Address - Phone:940-767-3797
Practice Address - Fax:940-767-3591
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2020-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK1824207RS0010X, 207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No207RS0010XAllopathic & Osteopathic PhysiciansInternal MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX030676301Medicaid
TX030676301Medicaid
TX005920Medicare ID - Type Unspecified