Provider Demographics
NPI:1619358447
Name:DAVID GONZALEZ,M.D.,PLLC
Entity type:Organization
Organization Name:DAVID GONZALEZ,M.D.,PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-260-0390
Mailing Address - Street 1:14439 NW MILITARY HWY
Mailing Address - Street 2:STE 108 PMB 619
Mailing Address - City:SHAVANO PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78231-1646
Mailing Address - Country:US
Mailing Address - Phone:210-260-0390
Mailing Address - Fax:210-408-2814
Practice Address - Street 1:14439 NW MILITARY HWY
Practice Address - Street 2:STE 108 PMB 619
Practice Address - City:SHAVANO PARK
Practice Address - State:TX
Practice Address - Zip Code:78231-1646
Practice Address - Country:US
Practice Address - Phone:210-260-0390
Practice Address - Fax:210-408-2814
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-17
Last Update Date:2015-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK55432084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty