Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0106X | Orthopaedic Hand Surgeon | 44655 | TX |
NPI | 1083976252 |
---|---|
Provider Name | Gilberto Agustin Gonzalez Trevizo |
First Address | El Paso, TX 79903-2300 |
Second Address | El Paso, TX 79905-2707 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2012 |
Last Update Date | 03/12/2014 |