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General NPI Number Information
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NPI Number | 1619358447
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Entity Type | Organization
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Legal Business Name | DAVID GONZALEZ,M.D.,PLLC
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Dates
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Enumeration Date | 06/17/2015
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Last Update Date | 06/17/2015
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Provider Practice Location Address
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Address Line | 14439 NW MILITARY HWY STE 108 PMB 619
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City | SHAVANO PARK
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State | TX
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Zip | 78231-1646
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Country | US
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Telephone | 210-260-0390
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Fax | 210-408-2814
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Provider Business Mailing Address
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Address Line | 14439 NW MILITARY HWY STE 108 PMB 619
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City | SHAVANO PARK
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State | TX
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Zip | 78231-1646
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Country | US
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Telephone | 210-260-0390
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Fax | 210-408-2814
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | DR. DAVID GONZALEZ
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Credential | M.D.
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Telephone | 210-260-0390
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | K5543
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License Number State | TX
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