Healthcare Provider Details

I. General information

NPI: 1700857927
Provider Name (Legal Business Name): JOHN J GONZALEZ JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2006
Last Update Date: 02/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8811 VILLAGE DR SUITE 300
SAN ANTONIO TX
78217-5415
US

IV. Provider business mailing address

PO BOX 928
SAN ANTONIO TX
78294-0928
US

V. Phone/Fax

Practice location:
  • Phone: 210-651-0303
  • Fax: 210-651-0302
Mailing address:
  • Phone: 210-651-0303
  • Fax: 210-651-0302

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberL2284
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: