Provider Demographics
NPI:1740741248
Name:GONZALES, GABRIEL R (DO)
Entity Type:Individual
Prefix:
First Name:GABRIEL
Middle Name:R
Last Name:GONZALES
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3221 DONNELLY CIR APT 1814
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107-5473
Mailing Address - Country:US
Mailing Address - Phone:325-201-8993
Mailing Address - Fax:
Practice Address - Street 1:3221 DONNELLY CIR APT 1814
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-5473
Practice Address - Country:US
Practice Address - Phone:325-201-8993
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-27
Last Update Date:2019-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program