Provider Demographics
NPI:1689709925
Name:GONZALEZ, JOSE A (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:A
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:PO BOX 2975
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78502-2975
Mailing Address - Country:US
Mailing Address - Phone:956-362-8170
Mailing Address - Fax:956-362-8168
Practice Address - Street 1:1100 E DOVE AVE STE 300
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-4672
Practice Address - Country:US
Practice Address - Phone:956-362-8170
Practice Address - Fax:956-362-8168
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2023-03-24
Deactivation Date:2007-07-27
Deactivation Code:
Reactivation Date:2007-08-02
Provider Licenses
StateLicense IDTaxonomies
TXM6152208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX186493601Medicaid
TX8K9034OtherBCBS
TX186493604Medicaid
TX8S4852OtherBCBS
TXBG8086488OtherDEA
TX186493602Medicaid
TXP00971790OtherRAILROAD
TX186493603Medicaid
TXP00448579OtherRAILROAD
TXP00971790OtherRAILROAD
TX186493602Medicaid
TX8J6764Medicare PIN