Provider Demographics
NPI:1316128549
Name:GONZALEZ, NARCISO III (MD)
Entity type:Individual
Prefix:DR
First Name:NARCISO
Middle Name:
Last Name:GONZALEZ
Suffix:III
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 1:2130 NE LOOP 410 STE 375
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78217-4661
Mailing Address - Country:US
Mailing Address - Phone:210-634-1232
Mailing Address - Fax:210-634-1243
Practice Address - Street 1:2130 NE LOOP 410 STE 375
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-4659
Practice Address - Country:US
Practice Address - Phone:210-634-1232
Practice Address - Fax:210-634-1243
Is Sole Proprietor?:No
Enumeration Date:2007-11-15
Last Update Date:2018-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN0799207LP2900X, 208VP0014X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX214705001Medicaid
TX214705002OtherMEDICAID (CSCHN)
TXTXB105135Medicare PIN