Healthcare Provider Details

I. General information

NPI: 1326029869
Provider Name (Legal Business Name): DAGOBERTO I GONZALEZ JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/10/2005
Last Update Date: 06/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7109 BARTLETT AVE SUTE 101
LAREDO TX
78041
US

IV. Provider business mailing address

7109 BARTLETT AVE SUTE 101
LAREDO TX
78041
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 NumberK3902
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: