Provider Demographics
NPI:1386694248
Name:GONZALEZ, RUBEN DAVID (MD)
Entity type:Individual
Prefix:DR
First Name:RUBEN
Middle Name:DAVID
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:122 W JOHN CARPENTER FWY STE 420
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75039-2014
Mailing Address - Country:US
Mailing Address - Phone:469-488-4300
Mailing Address - Fax:469-488-4301
Practice Address - Street 1:4351 DFW TPKE STE 150
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75211-1421
Practice Address - Country:US
Practice Address - Phone:469-488-4300
Practice Address - Fax:469-488-4301
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-11
Last Update Date:2021-10-14
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Provider Licenses
StateLicense IDTaxonomies
TXS8312208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRE62750Medicare UPIN