Provider Demographics
NPI:1336305663
Name:GONZALEZ, CARLOS (MD)
Entity Type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:CARLOS
Other - Middle Name:
Other - Last Name:GONZALEZ-SANDOVAL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1540 N ZARAGOZA RD
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-7905
Mailing Address - Country:US
Mailing Address - Phone:915-592-3323
Mailing Address - Fax:915-593-8571
Practice Address - Street 1:1540 N ZARAGOZA RD
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-7905
Practice Address - Country:US
Practice Address - Phone:915-592-3323
Practice Address - Fax:915-593-8571
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-06
Last Update Date:2020-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP0979207X00000X, 207X00000X
TXPHYTEMP207XS0114X
CAA96278207X00000X
GA64813207XS0114X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB138198Medicare PIN