Organization
DR. G CLINIC, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARIO G GONZALEZ MD (OWNER)
(575) 636-4877
Entity
Organization
Contact information
Practice address
4913 RUFE SNOW DR STE 102, NORTH RICHLAND HILLS, TX 76180-7856
(275) 636-4877
Mailing address
1032 VALLE VISTA LN, KELLER, TX 76248-4050
(575) 636-4877
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
P4959
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
329998401
—
TX
Enumeration date
06/05/2017
Last updated
06/05/2017
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