Provider Demographics
NPI:1134866221
Name:GONZALEZ, MARK ANTHONY (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:ANTHONY
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2810 N BEN WILSON ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77901
Mailing Address - Country:US
Mailing Address - Phone:361-485-6500
Mailing Address - Fax:361-485-6501
Practice Address - Street 1:2810 N. BEN WILSON ST.
Practice Address - Street 2:SUITE 200
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77901
Practice Address - Country:US
Practice Address - Phone:361-485-6500
Practice Address - Fax:361-485-6501
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-19
Last Update Date:2025-05-28
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Provider Licenses
StateLicense IDTaxonomies
TXU6960207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXBP10078510OtherPHYSICIAN IN TRAINING LICENSE
TXU6960OtherTEXAS MEDICAL BOARD LICENSE