Provider Demographics
NPI:1265432314
Name:VARGAS, GONZALO M (MD)
Entity type:Individual
Prefix:
First Name:GONZALO
Middle Name:M
Last Name:VARGAS
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 3567
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77253-3567
Mailing Address - Country:US
Mailing Address - Phone:713-790-5227
Mailing Address - Fax:713-790-5505
Practice Address - Street 1:7737 SOUTHWEST FWY
Practice Address - Street 2:SUITE 201
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074-1807
Practice Address - Country:US
Practice Address - Phone:713-776-0655
Practice Address - Fax:713-776-1069
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2009-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF2489208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX89824BOtherBCBS
TX128151102Medicaid
1468354OtherECFMG
TX128151102Medicaid
TX89824BMedicare PIN