Organization
PETER C. W. GONZALES, M.D., P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PETER CHAN WONG GONZALES M.D. (PRESIDENT)
(972) 870-5500
Entity
Organization
Contact information
Practice address
3204 N MACARTHUR BLVD, SUITE B, IRVING, TX 75062-4453
(972) 870-5500
(972) 870-5504
Mailing address
3204 N MACARTHUR BLVD, SUITE B, IRVING, TX 75062-4453
(972) 870-5500
(972) 870-5504
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
—
—
2084N0402X
Neurology with Special Qualifications in Child Neurology Physician
—
—
2084N0600X
Clinical Neurophysiology Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0053BF
BLUE CROSS BLUE SHIELD
TX
Enumeration date
05/17/2006
Last updated
07/13/2007
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