Provider Demographics
NPI:1740506385
Name:GONZALES, JIMMY GAMEZ (MD)
Entity type:Individual
Prefix:MR
First Name:JIMMY
Middle Name:GAMEZ
Last Name:GONZALES
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:PO BOX 4624
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78502-4624
Mailing Address - Country:US
Mailing Address - Phone:956-362-8383
Mailing Address - Fax:956-362-8382
Practice Address - Street 1:1601 E SPRAGUE ST
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78542-5260
Practice Address - Country:US
Practice Address - Phone:956-362-8383
Practice Address - Fax:956-362-8382
Is Sole Proprietor?:No
Enumeration Date:2010-04-07
Last Update Date:2025-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TXP3159207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX313174003Medicaid
TX313174004OtherMEDICAID CSHCN PROGRAM
TX269670ZK0DMedicare PIN