Basic Information
| Provider Information | |||||||||
| NPI: | 1386628246 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BOX | ||||||||
| FirstName: | GLORIA | ||||||||
| MiddleName: | GONZALEZ | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 587 | ||||||||
| Address2: | |||||||||
| City: | GONZALES | ||||||||
| State: | TX | ||||||||
| PostalCode: | 786290587 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8306728502 | ||||||||
| FaxNumber: | 8306723035 | ||||||||
| Practice Location | |||||||||
| Address1: | 1110 N. SARAH DEWITT DR | ||||||||
| Address2: | |||||||||
| City: | GONZALES | ||||||||
| State: | TX | ||||||||
| PostalCode: | 786294112 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8306728502 | ||||||||
| FaxNumber: | 8306723035 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/05/2005 | ||||||||
| LastUpdateDate: | 09/02/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | H9811 | TX | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 043630501 | 05 | TX | MEDICAID |