Provider Demographics
NPI:1730259839
Name:GONZALEZ, DAMARY (M D)
Entity type:Individual
Prefix:
First Name:DAMARY
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 26726
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78755-0726
Mailing Address - Country:US
Mailing Address - Phone:512-407-8686
Mailing Address - Fax:512-406-6216
Practice Address - Street 1:1401 MEDICAL PKWY, BLDG. B #220
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-7464
Practice Address - Country:US
Practice Address - Phone:512-324-4083
Practice Address - Fax:512-324-4717
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2013-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM5190207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX184402903Medicaid
TX184402905Medicaid
TX184402906Medicaid
TX184402902Medicaid
TX184402902Medicaid
TXTXB154839Medicare PIN
TXTXB154840Medicare PIN
TX8K7465Medicare PIN
TX184402903Medicaid
TXP01160237Medicare PIN