Individual
EDUARDO JOSE GONZALEZ BONILLA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
120 E BEAUREGARD AVE, SAN ANGELO, TX 76903-5919
(325) 658-1511
Mailing address
PO BOX 22000, SAN ANGELO, TX 76902-7200
(325) 658-1511
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
S2786
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
401122301
—
TX
01
—
8LMN32
BCBS
TX
Enumeration date
10/10/2014
Last updated
08/19/2022
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