Healthcare Provider Details

I. General information

NPI: 1275556219
Provider Name (Legal Business Name): ASHLEY M GONZALEZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ASHLEY MICHELLE BOURGEOIS

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 11/20/2023
Certification Date: 11/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 W 38TH ST STE 100
AUSTIN TX
78731-6404
US

IV. Provider business mailing address

1600 W 38TH ST STE 100
AUSTIN TX
78731-6404
US

V. Phone/Fax

Practice location:
  • Phone: 512-458-5323
  • Fax: 512-458-2030
Mailing address:
  • Phone: 512-458-5323
  • Fax: 512-458-2030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME95658
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: