MEDICARE: DR. ANTONIO SANTILLAN-GOMEZ 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	207VX0201X	Gynecologic Oncology Physician	M8316	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
2	P01701266	OTHER	TX	RAILROAD
3	8CH834	OTHER	TX	BCBS
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013055813
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANTONIO SANTILLAN-GOMEZ M.D.

Provider Business Mailing Address
First Line	:	PO BOX 911230
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75391-1230
Country	:	US
Telephone Number	:	972-997-8000
Fax Number	:	972-234-2987

Provider Business Practice Location Address
First Line	:	4411 MEDICAL DR
Second Line	:	STE. 100
City	:	SAN ANTONIO
State	:	TX
Zip	:	78229-3822
Country	:	US
Telephone Number	:	210-595-5300
Fax Number	:	210-595-5301

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

Provider Enumeration Date	:	02/02/2007
Last Update Date	:	04/11/2017

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Directions to “ DR. ANTONIO SANTILLAN-GOMEZ M.D.” Practice Location

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