Provider Demographics
NPI:1982632279
Name:MID VALLEY INTERNISTS PA
Entity Type:Organization
Organization Name:MID VALLEY INTERNISTS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:GABRIEL
Authorized Official - Middle Name:C
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-968-7528
Mailing Address - Street 1:1330 E 6TH ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WESLACO
Mailing Address - State:TX
Mailing Address - Zip Code:78596-4204
Mailing Address - Country:US
Mailing Address - Phone:956-968-7528
Mailing Address - Fax:956-973-0297
Practice Address - Street 1:1330 E 6TH ST
Practice Address - Street 2:SUITE 101
Practice Address - City:WESLACO
Practice Address - State:TX
Practice Address - Zip Code:78596-4204
Practice Address - Country:US
Practice Address - Phone:956-968-7528
Practice Address - Fax:956-973-0297
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-28
Last Update Date:2008-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH3248207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00Z508Medicare PIN
TXE43865Medicare UPIN