Provider Demographics
NPI:1902537186
Name:EXPRESS OCCUPATIONAL MEDICINE CLINIC
Entity Type:Organization
Organization Name:EXPRESS OCCUPATIONAL MEDICINE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BENITO
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZELEZ
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:956-504-7245
Mailing Address - Street 1:3120 INTERNATIONAL BLVD
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78521-3214
Mailing Address - Country:US
Mailing Address - Phone:956-504-7245
Mailing Address - Fax:956-504-7237
Practice Address - Street 1:3120 INTERNATIONAL BLVD
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78521-3214
Practice Address - Country:US
Practice Address - Phone:956-504-7245
Practice Address - Fax:956-504-7237
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-20
Last Update Date:2022-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty