Provider Demographics
NPI:1922026871
Name:VICTOR M GONZALEZ ,JR.,M.D.,P.A.
Entity Type:Organization
Organization Name:VICTOR M GONZALEZ ,JR.,M.D.,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:MANUEL
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:956-546-5773
Mailing Address - Street 1:1144 PROFESSIONAL DR
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78520-6461
Mailing Address - Country:US
Mailing Address - Phone:956-546-5773
Mailing Address - Fax:956-546-1397
Practice Address - Street 1:1144 PROFESSIONAL DR
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78520-6461
Practice Address - Country:US
Practice Address - Phone:956-546-5773
Practice Address - Fax:956-546-1397
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG-9276173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB87843Medicare UPIN
TX00103NMedicare ID - Type Unspecified