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General NPI Number Information
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NPI Number | 1154830289
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Entity Type | Organization
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Legal Business Name | STAR PAIN & SPINE LLC
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Dates
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Enumeration Date | 09/20/2017
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Last Update Date | 10/29/2025
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Provider Practice Location Address
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Address Line | 4221 MEDICAL PKWY STE 250
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City | CARROLLTON
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State | TX
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Zip | 75010-4543
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Country | US
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Telephone | 469-925-3133
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Fax | 972-942-0102
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Provider Business Mailing Address
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Address Line | 4221 MEDICAL PKWY STE 250
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City | CARROLLTON
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State | TX
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Zip | 75010-4543
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Country | US
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Telephone | 469-925-3133
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Fax | 972-942-0103
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Authorized Official
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Title or Position | OWNER
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Name | DR. GONZALO GONZALES JR.
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Credential | D.O.
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Telephone | 469-925-3133
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2081P2900X
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Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | N6319
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License Number State | TX
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