Provider Demographics
NPI:1972585982
Name:GONZALEZ, ELOISA THELMA (MD)
Entity Type:Individual
Prefix:DR
First Name:ELOISA
Middle Name:THELMA
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 1:825 LAKESIDE BLVD
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78520-7616
Mailing Address - Country:US
Mailing Address - Phone:956-542-7999
Mailing Address - Fax:956-544-5059
Practice Address - Street 1:825 LAKESIDE BLVD
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78520-7616
Practice Address - Country:US
Practice Address - Phone:956-542-7999
Practice Address - Fax:956-544-5059
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-16
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH4829208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX092722002Medicaid
TX092722001Medicaid
TX742995152OtherTAX ID
TX092722001Medicaid