Provider Demographics
NPI:1942536313
Name:GONZALEZ, MICHAEL (PA-C)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 66
Mailing Address - Street 2:119 RETAMA SUITE D
Mailing Address - City:ELSA
Mailing Address - State:TX
Mailing Address - Zip Code:78543-0066
Mailing Address - Country:US
Mailing Address - Phone:956-262-9940
Mailing Address - Fax:956-262-9960
Practice Address - Street 1:119 RETAMA
Practice Address - Street 2:SUITE D
Practice Address - City:ELSA
Practice Address - State:TX
Practice Address - Zip Code:78543-0066
Practice Address - Country:US
Practice Address - Phone:956-262-9940
Practice Address - Fax:956-262-9960
Is Sole Proprietor?:No
Enumeration Date:2009-10-20
Last Update Date:2014-03-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXPA02600363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant