Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 11015 | TX |
NPI | 1093729568 |
---|---|
Provider Name | Dr. Raymond Edward Gonzalez |
First Address | Victoria, TX 77901-4423 |
Second Address | Victoria, TX 77901-4448 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2006 |
Last Update Date | 08/07/2007 |