Healthcare Provider Details

I. General information

NPI: 1740241629
Provider Name (Legal Business Name): EDUARDO A GONZALEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2006
Last Update Date: 02/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 E RANDOL MILL RD
ARLINGTON TX
76011-5834
US

IV. Provider business mailing address

121 E RANDOL MILL RD
ARLINGTON TX
76011-5834
US

V. Phone/Fax

Practice location:
  • Phone: 817-860-1309
  • Fax:
Mailing address:
  • Phone: 817-860-1309
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberG8136
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: