MEDICARE: JOHN J GONZALEZ JR. M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	L2284	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1700857927
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN J GONZALEZ JR. M.D.

Provider Business Mailing Address
First Line	:	PO BOX 928
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78294-0928
Country	:	US
Telephone Number	:	210-651-0303
Fax Number	:	210-651-0302

Provider Business Practice Location Address
First Line	:	8811 VILLAGE DR
Second Line	:	SUITE 300
City	:	SAN ANTONIO
State	:	TX
Zip	:	78217-5415
Country	:	US
Telephone Number	:	210-651-0303
Fax Number	:	210-651-0302

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/27/2006
Last Update Date	:	02/23/2012

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