1063648152 NPI number — DR. JOSE LUIS GONZALES JR. D.C.

Table of content: DR. JOSE LUIS GONZALES JR. D.C. (NPI 1063648152)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063648152 NPI number — DR. JOSE LUIS GONZALES JR. D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GONZALES
Provider First Name:
JOSE
Provider Middle Name:
LUIS
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
JR.
Provider Credential Text:
D.C.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1063648152
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/03/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6025 ROYAL LN
Provider Second Line Business Mailing Address:
SUITE 120
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75230-3892
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-529-1904
Provider Business Mailing Address Fax Number:
214-265-8444

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6025 ROYAL LN
Provider Second Line Business Practice Location Address:
SUITE 120
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75230-3892
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-529-1904
Provider Business Practice Location Address Fax Number:
214-265-8444
Provider Enumeration Date:
06/03/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111NR0400X , with the licence number:  11149 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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