Basic Information
| Provider Information | |||||||||
| NPI: | 1114979572 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GONZALEZ | ||||||||
| FirstName: | JOSE | ||||||||
| MiddleName: | ENCARNACION | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11861 PHYSICIANS DR | ||||||||
| Address2: | |||||||||
| City: | EL PASO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 799366280 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9157905700 | ||||||||
| FaxNumber: | 9155217928 | ||||||||
| Practice Location | |||||||||
| Address1: | 11861 PHYSICIANS DR | ||||||||
| Address2: | |||||||||
| City: | EL PASO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 799366280 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9157905700 | ||||||||
| FaxNumber: | 9155217928 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/16/2006 | ||||||||
| LastUpdateDate: | 10/19/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/19/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | L2905 | TX | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207Q00000X | L2905 | TX | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 156195301 | 05 | TX | MEDICAID | 8F8441 | 01 | TX | BCBS OF TEXAS | OTHER | 080191737 | 01 | TX | RAILROAD MEDICARE | OTHER |