Provider Demographics
NPI:1932167889
Name:GONZALEZ, DAVID (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
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 1:7711 LOUIS PASTEUR DR STE 707
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3422
Mailing Address - Country:US
Mailing Address - Phone:210-575-7828
Mailing Address - Fax:866-741-3697
Practice Address - Street 1:8026 FLOYD CURL DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3915
Practice Address - Country:US
Practice Address - Phone:210-575-8229
Practice Address - Fax:210-575-8127
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2011-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK55432084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX105388604Medicaid
TX8U9620OtherBCBS
P00615270OtherMEDICARE RR
G81405Medicare UPIN
TX8F1973Medicare ID - Type Unspecified