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General NPI Number Information
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NPI Number | 1710061239
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Entity Type | Individual
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Provider Name | MANUEL J GONZALEZ MD
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Gender | Male
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Dates
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Enumeration Date | 10/24/2006
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Last Update Date | 02/26/2013
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Provider Practice Location Address
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Address Line | 1101 CORPUS CHRISTI ST
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City | LAREDO
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State | TX
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Zip | 78040-5258
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Country | US
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Telephone | 956-727-8470
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Fax | 956-727-4933
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Provider Business Mailing Address
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Address Line | 1101 CORPUS CHRISTI ST
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City | LAREDO
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State | TX
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Zip | 78040-5258
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Country | US
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Telephone | 956-727-8470
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Fax | 956-727-4933
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | E4356
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License Number State | TX
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