Provider Demographics
NPI:1073781142
Name:GONZALEZ, ANTONIO VICTOR PRUDENTE (MD)
Entity type:Individual
Prefix:
First Name:ANTONIO VICTOR
Middle Name:PRUDENTE
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:4461 COIT RD
Mailing Address - Street 2:STE 409
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75035-0526
Mailing Address - Country:US
Mailing Address - Phone:214-396-8877
Mailing Address - Fax:214-983-0983
Practice Address - Street 1:118 LYNN AVE STE 100
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75057-3706
Practice Address - Country:US
Practice Address - Phone:214-396-8877
Practice Address - Fax:214-983-0983
Is Sole Proprietor?:No
Enumeration Date:2008-02-12
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101242453207RI0200X
TXT2172207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC06304Medicare PIN