Healthcare Provider Details

I. General information

NPI: 1679267520
Provider Name (Legal Business Name): GONZALO FRANCISCO CEDILLO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2023
Last Update Date: 06/05/2023
Certification Date: 06/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 UNIVERSITY BLVD
GALVESTON TX
77555-5303
US

IV. Provider business mailing address

7146 N HOLIDAY DR
GALVESTON TX
77550-3032
US

V. Phone/Fax

Practice location:
  • Phone: 409-772-0001
  • Fax: 409-772-5611
Mailing address:
  • Phone: 956-592-7596
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number765659
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: