NPIMap

Organization Active NPI

Obstetrics and Gynecology Associates of Laredo, P.a.

  • Obstetrics & Gynecology Physician
  • Laredo, TX
National Provider Identifier
1114908803
Registry record updated Jul 3, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
Legal business name
OBSTETRICS AND GYNECOLOGY ASSOCIATES OF LAREDO, P.A.
Practice address
7109 North Bartlett Ave Sute 101
Laredo, TX 78041-6473
Phone
(956) 717-5775
Fax
(956) 717-5875
NPI assigned
Nov 9, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 3, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Dagoberto I Gonzalez Jr., MDNPI 1326029869
Title
Owner
Phone
(956) 717-5775

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207V00000X Primary

Addresses

Primary practice location

7109 North Bartlett Ave Sute 101
Laredo, TX 78041-6473

Mailing address

7109 North Bartlett Ave Sute 101
Laredo, TX 78041-6473
Phone (956) 717-5775

Other identifiers 2

IdentifierTypeStateIssuer
1654675-01MedicaidTX
0016LMOtherTXBLUE CROSS BLUE SHIELD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040630000085 TX Part B Supplier - Clinic/Group Practice 6901883834 Receives reassigned benefits from 5 practitioners
Practice locations: Laredo, TX

National Provider Directory

National Provider Directory

Locations

7109 N Bartlett Ave
Ste 101
Laredo, TX 78041
Phone (956) 717-5775

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1131494400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1562112000000",
    "number": "1114908803",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7109 NORTH BARTLETT AVE SUTE 101",
            "city": "LAREDO",
            "state": "TX",
            "postal_code": "780416473",
            "telephone_number": "956-717-5775",
            "fax_number": "956-717-5875"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7109 NORTH BARTLETT AVE SUTE 101",
            "city": "LAREDO",
            "state": "TX",
            "postal_code": "780416473",
            "telephone_number": "956-717-5775",
            "fax_number": "956-717-5875"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OBSTETRICS AND GYNECOLOGY ASSOCIATES OF LAREDO, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-11-09",
        "last_updated": "2019-07-03",
        "status": "A",
        "authorized_official_last_name": "GONZALEZ",
        "authorized_official_first_name": "DAGOBERTO",
        "authorized_official_middle_name": "I",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "956-717-5775",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1654675-01",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "0016LM",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Laredo, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 3, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.