Provider Demographics
NPI:1700818416
Name:GONZALEZ, ERNEST A (MD)
Entity Type:Individual
Prefix:
First Name:ERNEST
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 1:4310 JAMES CASEY ST STE 3C
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78745-1120
Mailing Address - Country:US
Mailing Address - Phone:512-326-2800
Mailing Address - Fax:512-441-6388
Practice Address - Street 1:4310 JAMES CASEY ST STE 3C
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-1120
Practice Address - Country:US
Practice Address - Phone:512-326-2800
Practice Address - Fax:512-441-6388
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL3978208600000X, 2086S0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX151830001Medicaid
TX151830001Medicaid
TX1700818416Medicare PIN