Provider Demographics
NPI:1154393817
Name:GONZALEZ PENIZA, LUIS M (MD)
Entity type:Individual
Prefix:
First Name:LUIS
Middle Name:M
Last Name:GONZALEZ PENIZA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4418 N. MCCOLL
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504
Mailing Address - Country:US
Mailing Address - Phone:956-580-8072
Mailing Address - Fax:956-583-3050
Practice Address - Street 1:4418 N. MCCOLL
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504
Practice Address - Country:US
Practice Address - Phone:956-580-8072
Practice Address - Fax:956-583-3050
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2014-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ6969207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX029989303Medicaid
TXP00268590OtherRAILROAD MEDICARE
8U5312OtherBLUE CROSS BLUE SHIELD
F87640Medicare UPIN
TXP00268590OtherRAILROAD MEDICARE