Provider Demographics
NPI:1023702255
Name:JUAN DIEGO GONZALEZ MD PA
Entity type:Organization
Organization Name:JUAN DIEGO GONZALEZ MD PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:DIEGO
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-544-5700
Mailing Address - Street 1:3125 W ALTON GLOOR BLVD
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78520-3506
Mailing Address - Country:US
Mailing Address - Phone:956-544-5700
Mailing Address - Fax:956-350-9573
Practice Address - Street 1:3125 W ALTON GLOOR BLVD
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78520-3506
Practice Address - Country:US
Practice Address - Phone:956-544-5700
Practice Address - Fax:956-350-9573
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-08
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty