Provider Demographics
NPI:1992776116
Name:GONZALEZ, ALFREDO ERNESTO (MD)
Entity type:Individual
Prefix:DR
First Name:ALFREDO
Middle Name:ERNESTO
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:125 W HAGUE RD
Mailing Address - Street 2:SUITE 570
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-5814
Mailing Address - Country:US
Mailing Address - Phone:915-544-7767
Mailing Address - Fax:915-532-6938
Practice Address - Street 1:125 W HAGUE RD
Practice Address - Street 2:SUITE 570
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-5814
Practice Address - Country:US
Practice Address - Phone:915-544-7767
Practice Address - Fax:915-532-6938
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2007-08-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXK0044207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
G25863Medicare UPIN