Provider Demographics
NPI:1245468396
Name:GONZALEZ, GABRIEL B (MD)
Entity type:Individual
Prefix:
First Name:GABRIEL
Middle Name:B
Last Name:GONZALEZ
Suffix:
Gender:M
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:PO BOX 846098
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-6098
Mailing Address - Country:US
Mailing Address - Phone:903-324-6400
Mailing Address - Fax:
Practice Address - Street 1:18707 HARDY OAK BLVD STE 230
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-4890
Practice Address - Country:US
Practice Address - Phone:210-494-2000
Practice Address - Fax:210-494-6119
Is Sole Proprietor?:No
Enumeration Date:2009-06-28
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD452910207V00000X
TXT3287207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102955458Medicaid
PA102955458Medicaid