Healthcare Provider Details

I. General information

NPI: 1932216934
Provider Name (Legal Business Name): GREGORY G GOODWILER PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 11/14/2025
Certification Date: 11/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4502 MEDICAL DR
SAN ANTONIO TX
78229-4402
US

IV. Provider business mailing address

7500 BARLITE BLVD STE 311
SAN ANTONIO TX
78224-1363
US

V. Phone/Fax

Practice location:
  • Phone: 210-450-6470
  • Fax:
Mailing address:
  • Phone: 210-450-4000
  • Fax: 210-450-4903

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA02212
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: