Provider Demographics
NPI:1598767253
Name:GONZALEZ, JUAN M (MD)
Entity type:Individual
Prefix:DR
First Name:JUAN
Middle Name:M
Last Name:GONZALEZ
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6560 FANNIN ST STE 1824
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2735
Mailing Address - Country:US
Mailing Address - Phone:713-790-9080
Mailing Address - Fax:713-790-0766
Practice Address - Street 1:6560 FANNIN ST STE 1824
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2735
Practice Address - Country:US
Practice Address - Phone:713-790-9080
Practice Address - Fax:713-790-0766
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH4937207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX134104201Medicaid
TX390007310OtherMEDICARE RAILROAD
TX8637K1OtherBLUE CROSS BLUE SHIELD