Provider Demographics
NPI:1801828611
Name:GONZALEZ, NANCY (MD)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:DEL
Other - Last Name:ROSARIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:8702 SPRING VALLEY RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75240-4230
Mailing Address - Country:US
Mailing Address - Phone:214-295-6625
Mailing Address - Fax:214-295-6211
Practice Address - Street 1:8702 SPRING VALLEY RD
Practice Address - Street 2:SUITE A
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75240-4230
Practice Address - Country:US
Practice Address - Phone:214-295-6625
Practice Address - Fax:214-295-6211
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2016-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG6799207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX140184635Medicaid
TXTXB151556OtherMEDICARE ID TYPE UNSPECIFIED
TXD48209Medicare UPIN