Provider Demographics
NPI:1902010036
Name:AURORA GONZALEZ M.D. & FERNANDO R. BUESO M.D.,P.A.
Entity Type:Organization
Organization Name:AURORA GONZALEZ M.D. & FERNANDO R. BUESO M.D.,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:MR
Authorized Official - First Name:TED
Authorized Official - Middle Name:
Authorized Official - Last Name:ECKENROD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-757-1076
Mailing Address - Street 1:1315 ST JOSEPH PKWY
Mailing Address - Street 2:SUITE # 1507
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77002-8233
Mailing Address - Country:US
Mailing Address - Phone:713-757-1075
Mailing Address - Fax:713-652-3918
Practice Address - Street 1:1315 ST JOSEPH PKWY
Practice Address - Street 2:SUITE # 1507
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77002-8233
Practice Address - Country:US
Practice Address - Phone:713-757-1075
Practice Address - Fax:713-652-3918
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE8363207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXC13915Medicare UPIN
TXI09826Medicare UPIN
TXH25262Medicare UPIN