Martin D Gonzalez, FNP
Individual provider Active NPI Nurse Practitioner · Clyde, TX
NPI 1669775102 · NPPES record last updated Feb 20, 2013
Key facts
- NPI
- 1669775102
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Nurse Practitioner 363L00000X
- License
- 714984 (TX)
- Practice address
- 1712 N Access Rd
Clyde, TX 79510 - Phone
- (325) 893-4010
- Fax
- (325) 893-4035
- NPI assigned
- Dec 6, 2010
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20151119000496 | TX | Practitioner - Nurse Practitioner | 5395986814 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Health and Human Services Commission | Current |
Accepting new patients | |
| Health and Human Services Commission | Nurse Practitioner | Current | Accepting new patients |
Locations
2501 Maple St
Abilene, TX 79602
Phone (325) 692-4053
4001 Highway 36 S
Brenham, TX 77833
Phone (979) 277-1327
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 714984 | TX | Yes |
Addresses
Primary practice location
1712 N Access Rd
Clyde, TX 79510
Mailing address
PO Box 2435
Albany, TX 76430-8020
Phone (325) 893-4010
Other providers in Clyde, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 20, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.