Healthcare Provider Details

I. General information

NPI: 1215956545
Provider Name (Legal Business Name): ABELARDO G. GONZALEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 07/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 NE LOOP 410 SUITE 900
SAN ANTONIO TX
78216-5832
US

IV. Provider business mailing address

45 N.E. LOOP 410 #900
SAN ANTONIO TX
78215
US

V. Phone/Fax

Practice location:
  • Phone: 210-375-7780
  • Fax: 210-375-7789
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberK5542
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: