Provider Demographics
NPI:1124075825
Name:JUAN J GONZALEZ-DICKSON, M.D., P.A.
Entity type:Organization
Organization Name:JUAN J GONZALEZ-DICKSON, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:GONZALEZ-DICKSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-968-0802
Mailing Address - Street 1:909 JAMES ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:WESLACO
Mailing Address - State:TX
Mailing Address - Zip Code:78596-4209
Mailing Address - Country:US
Mailing Address - Phone:956-968-0802
Mailing Address - Fax:956-969-3242
Practice Address - Street 1:909 JAMES ST
Practice Address - Street 2:SUITE A
Practice Address - City:WESLACO
Practice Address - State:TX
Practice Address - Zip Code:78596-4209
Practice Address - Country:US
Practice Address - Phone:956-968-0802
Practice Address - Fax:956-969-3242
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-28
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0015PLOtherBCBSTX
TX182556401Medicaid
TX=========OtherTAX ID NUMBER