Healthcare Provider Details

I. General information

NPI: 1730971482
Provider Name (Legal Business Name): BRANDON GONZALEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2025
Last Update Date: 05/20/2025
Certification Date: 05/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 HARBORSIDE DRIVE SUITE 104
GALVESTON TX
77555-0001
US

IV. Provider business mailing address

FAMILY MEDICINE RESIDENCY PROGRAM 301 UNIVERSITY BLVD
GALVESTON TX
77555-1123
US

V. Phone/Fax

Practice location:
  • Phone: 409-772-2166
  • Fax: 409-772-2663
Mailing address:
  • Phone: 409-747-8593
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberBP10094057
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: