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General NPI Number Information
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NPI Number | 1952456915
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Entity Type | Individual
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Provider Name | MARSHALL A. GONZALES PA-C
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Gender | Male
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Dates
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Enumeration Date | 01/23/2007
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Last Update Date | 08/04/2011
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Provider Practice Location Address
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Address Line | 6620 MAIN ST SUITE 1325
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City | HOUSTON
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State | TX
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Zip | 77030-2348
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Country | US
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Telephone | 713-798-4001
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Fax | 713-798-6005
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Provider Business Mailing Address
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Address Line | 2 GREENWAY PLZ SUITE 900
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City | HOUSTON
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State | TX
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Zip | 77046-0297
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Country | US
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Telephone | 713-798-1750
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Fax | 713-798-1144
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA00130
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License Number State | TX
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