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Individual

WALDO GONZALEZ

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
302 MEDICAL PARK DR, SUITE 101, LUFKIN, TX 75904-3148
(936) 634-8216
(936) 634-8723
Mailing address
PO BOX 150507, LUFKIN, TX 75915-0507
(936) 634-8216
(936) 634-8723

Taxonomy

Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
D2889
TX
208600000X
Surgery Physician
Primary
D2889
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
138116203
TX
01
E327
BLUE CROSS
TX
Enumeration date
01/11/2007
Last updated
07/01/2008
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