Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | 131 | TX |
N | 222Z00000X | Podiatrist | 131 | TX |
N | 224P00000X | Prosthetist | 131 | TX |
N | 224P00000X | Prosthetist | CP001022 | TX |
NPI | 1326252560 |
---|---|
Provider Name | Prof. Richard H Gonzales |
First Address | Longview, TX 75601-6512 |
Second Address | Longview, TX 75601-6512 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/05/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
69606542 | BLUE CROSS BLUE SHIELD (01) | TX |