| |
3125 W Alton Gloor Blvd Brownsville TX 78520-3506 | |
(956) 544-5700 | |
(956) 350-9573 |
Full Name | |
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Speciality | Internal Medicine |
Location | 3125 W Alton Gloor Blvd, Brownsville, Texas |
Authorized Official Name and Position | Juan Diego Gonzalez (AUTHORIZED OFFICIAL) |
Authorized Official Contact | 9565445700 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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3125 W Alton Gloor Blvd Brownsville TX 78520-3506 Ph: (956) 544-5700 | 3125 W Alton Gloor Blvd Brownsville TX 78520-3506 Ph: (956) 544-5700 |
NPI Number | 1023702255 |
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Provider Enumeration Date | 06/08/2023 |
Last Update Date | 08/15/2024 |
Medicare PECOS PAC ID | 2163955972 |
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Medicare Enrollment ID | O20241101000192 |
Identifier | Type | State | Issuer |
---|---|---|---|
1023702255 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207R00000X | Internal Medicine | (* (Not Available)) | Primary |
Provider Name | Juan Diego Gonzalez |
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Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1083140917 PECOS PAC ID: 2860814720 Enrollment ID: I20200623000202 |
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