1083989768 NPI number — DR. ABIEL E. GONZALEZ III D.C.

Table of content: DR. ABIEL E. GONZALEZ III D.C. (NPI 1083989768)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083989768 NPI number — DR. ABIEL E. GONZALEZ III D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GONZALEZ
Provider First Name:
ABIEL
Provider Middle Name:
E.
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
III
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:
1083989768
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/20/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1929 PAYTON GIN RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AUSTIN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78757-8501
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-302-4773
Provider Business Mailing Address Fax Number:
512-302-1678

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5920 W WILLIAM CANNON
Provider Second Line Business Practice Location Address:
BLDG 1, SUITE 100
Provider Business Practice Location Address City Name:
AUSTIN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78749-1902
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-302-4773
Provider Business Practice Location Address Fax Number:
512-302-1678
Provider Enumeration Date:
03/14/2012

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: 111NS0005X , with the licence number:  12024 , 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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