Provider Demographics
NPI:1154053940
Name:GONZALES, MICHAEL A
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:A
Last Name:GONZALES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4705 BRIARWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79707-2639
Mailing Address - Country:US
Mailing Address - Phone:432-505-4145
Mailing Address - Fax:833-941-0864
Practice Address - Street 1:4705 BRIARWOOD AVE
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79707-2639
Practice Address - Country:US
Practice Address - Phone:432-505-4145
Practice Address - Fax:833-941-0864
Is Sole Proprietor?:No
Enumeration Date:2022-06-29
Last Update Date:2025-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1073647363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty