Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QS0010X | Family Doctor - Sports Medicine | S3526 | TX |
NPI | 1275914566 |
---|---|
Provider Name | Armando M Gonzalez |
First Address | Malvern, PA 19355-0746 |
Second Address | Laredo, TX 78041 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/06/2015 |
Last Update Date | 22/10/2019 |