Provider Demographics
NPI:1952456915
Name:GONZALES, MARSHALL A (PA-C)
Entity Type:Individual
Prefix:MR
First Name:MARSHALL
Middle Name:A
Last Name:GONZALES
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:2 GREENWAY PLZ
Mailing Address - Street 2:SUITE 900
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77046-0297
Mailing Address - Country:US
Mailing Address - Phone:713-798-1750
Mailing Address - Fax:713-798-1144
Practice Address - Street 1:6620 MAIN ST
Practice Address - Street 2:SUITE 1325
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2348
Practice Address - Country:US
Practice Address - Phone:713-798-4001
Practice Address - Fax:713-798-6005
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2011-08-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXPA00130363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
R59554Medicare UPIN
TXTXB130281Medicare PIN
TXTXB126072Medicare PIN
080N089Medicare ID - Type UnspecifiedMDACC MEDICARE