MEDICARE: VICENTE GONZALEZ MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207PE0004X	Emergency Medical Services (Emergency Medicine) Physician	K9072	TX
2	207R00000X	Internal Medicine Physician	K9072	TX

General Provider Information

NPI Number	:	1336115286
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICENTE GONZALEZ MD

Provider Business Mailing Address
First Line	:	140 N CUATES CAMINO
Second Line	:
City	:	LOS FRESNOS
State	:	TX
Zip	:	78566-4314
Country	:	US
Telephone Number	:	956-233-8954
Fax Number	:	956-233-8954

Provider Business Practice Location Address
First Line	:	140 N CUATES CAMINO
Second Line	:
City	:	LOS FRESNOS
State	:	TX
Zip	:	78566-4314
Country	:	US
Telephone Number	:	956-233-8954
Fax Number	:	956-233-8954

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/28/2006
Last Update Date	:	03/11/2010

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