Provider Demographics
NPI:1356540215
Name:MORALES GONZALEZ, ANGEL MARIO (MD)
Entity type:Individual
Prefix:DR
First Name:ANGEL
Middle Name:MARIO
Last Name:MORALES GONZALEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1941 W T C JESTER BLVD # 102
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77008-1200
Mailing Address - Country:US
Mailing Address - Phone:713-777-5476
Mailing Address - Fax:
Practice Address - Street 1:10400 VISTA DEL SOL DR
Practice Address - Street 2:SUITE 101
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79925-7945
Practice Address - Country:US
Practice Address - Phone:915-422-7346
Practice Address - Fax:915-503-2292
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-12
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN56176208600000X
TXN0289208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
N0289OtherTX MEDICAL LIC