Provider Demographics
NPI:1013971597
Name:GONZAGA, FE Q (MD)
Entity Type:Individual
Prefix:
First Name:FE
Middle Name:Q
Last Name:GONZAGA
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 1:529 W WHEATLAND RD
Mailing Address - Street 2:
Mailing Address - City:DUNCANVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75137
Mailing Address - Country:US
Mailing Address - Phone:972-780-0341
Mailing Address - Fax:972-780-0447
Practice Address - Street 1:529 W WHEATLAND RD
Practice Address - Street 2:
Practice Address - City:DUNCANVILLE
Practice Address - State:TX
Practice Address - Zip Code:75137
Practice Address - Country:US
Practice Address - Phone:972-780-0341
Practice Address - Fax:972-780-0447
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG0717207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine