Individual
DR. GONZALO LIEVANO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D
Contact information
Practice address
1307 8TH AVE, STE 306, FORT WORTH, TX 76104
(817) 912-8040
(817) 912-8049
Mailing address
1307 8TH AVE, STE 306, FORT WORTH, TX 76104
(817) 912-8040
(817) 912-8049
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
L5024
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
155486702
—
TX
05
—
155486703
—
TX
01
—
8S3521
BCBS
TX
Enumeration date
06/09/2006
Last updated
07/12/2012
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