Provider Demographics
NPI:1780662288
Name:GONZALEZ, ROBERTO (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERTO
Middle Name:
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 1:816 S 12TH ST
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78501-5009
Mailing Address - Country:US
Mailing Address - Phone:956-687-4220
Mailing Address - Fax:956-664-9243
Practice Address - Street 1:816 S 12TH ST
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78501-5009
Practice Address - Country:US
Practice Address - Phone:956-687-4220
Practice Address - Fax:956-664-9243
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-04
Last Update Date:2014-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF2686207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8S3760OtherBCBS
TX00ML31OtherBCBSTX
TX092624801Medicaid
TX092624803Medicaid
TXB87829Medicare UPIN
TX8A7253Medicare PIN
TX092624803Medicaid