Healthcare Provider Details

I. General information

NPI: 1114908803
Provider Name (Legal Business Name): OBSTETRICS AND GYNECOLOGY ASSOCIATES OF LAREDO, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2005
Last Update Date: 07/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7109 NORTH BARTLETT AVE SUTE 101
LAREDO TX
78041-6473
US

IV. Provider business mailing address

7109 NORTH BARTLETT AVE SUTE 101
LAREDO TX
78041-6473
US

V. Phone/Fax

Practice location:
  • Phone: 956-717-5775
  • Fax: 956-717-5875
Mailing address:
  • Phone: 956-717-5775
  • Fax: 956-717-5875

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. DAGOBERTO I GONZALEZ JR.
Title or Position: OWNER
Credential: MD
Phone: 956-717-5775