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General NPI Number Information
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NPI Number | 1255623906
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Entity Type | Organization
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Legal Business Name | INTERNAL MEDICINE GROUP PA
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Dates
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Enumeration Date | 05/12/2011
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Last Update Date | 05/12/2011
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Provider Practice Location Address
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Address Line | 1715 SAUL KLIENFIELD BLDG A
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City | EL PASO
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State | TX
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Zip | 79936
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Country | US
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Telephone | 915-222-8275
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Fax | 915-222-8297
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Provider Business Mailing Address
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Address Line | PO BOX 71449
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City | EL PASO
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State | TX
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Zip | 79917-1449
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Country | US
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Telephone | 915-222-8275
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Fax | 915-222-8297
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. OMAR GONZALEZ
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Credential | MD
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Telephone | 915-222-8275
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | K4440
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License Number State | TX
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