Provider Demographics
NPI:1841231446
Name:GONZALEZ, VIRGINIA YOLANDA (MD)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:YOLANDA
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 1:2595 DALLAS PKWY
Mailing Address - Street 2:SUITE 405
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-8527
Mailing Address - Country:US
Mailing Address - Phone:972-377-1490
Mailing Address - Fax:972-377-1499
Practice Address - Street 1:18780 INTERSTATE 20
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:TX
Practice Address - Zip Code:75103-3593
Practice Address - Country:US
Practice Address - Phone:903-567-4841
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA070362207Q00000X, 207R00000X
TXM4997207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX204267302OtherMEDICAID OTHER
TX204267303Medicaid
TX587504YMAFOtherMEDICARE
TX8HB435OtherBCBS
TXP01878880OtherMEDICARE RAIL ROAD
TX75-2616977-001OtherTRICARE
TX75-2616977-001OtherTRICARE