Basic Information
| Provider Information | |||||||||
| NPI: | 1669775102 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GONZALEZ | ||||||||
| FirstName: | MARTIN | ||||||||
| MiddleName: | D | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2435 | ||||||||
| Address2: | |||||||||
| City: | ALBANY | ||||||||
| State: | TX | ||||||||
| PostalCode: | 764308020 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3258934010 | ||||||||
| FaxNumber: | 3258934035 | ||||||||
| Practice Location | |||||||||
| Address1: | 1712 N ACCESS RD | ||||||||
| Address2: | |||||||||
| City: | CLYDE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 79510 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3258934010 | ||||||||
| FaxNumber: | 3258934035 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/06/2010 | ||||||||
| LastUpdateDate: | 02/20/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 714984 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.