Provider Demographics
NPI:1700265873
Name:GONZALO A AILLON MD PLLC
Entity Type:Organization
Organization Name:GONZALO A AILLON MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GONZALO
Authorized Official - Middle Name:A
Authorized Official - Last Name:AILLON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-943-9406
Mailing Address - Street 1:400 S ZANG BLVD
Mailing Address - Street 2:SUITE 802
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75208-6643
Mailing Address - Country:US
Mailing Address - Phone:214-943-9406
Mailing Address - Fax:214-944-5511
Practice Address - Street 1:400 S ZANG BLVD
Practice Address - Street 2:SUITE 802
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75208-6643
Practice Address - Country:US
Practice Address - Phone:214-943-9406
Practice Address - Fax:214-944-5511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-22
Last Update Date:2015-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD-77302084B0040X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084B0040XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyBehavioral Neurology & NeuropsychiatryGroup - Single Specialty