MEDICARE: JON R GONZALEZ DO

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	207Q00000X	Family Medicine Physician	5217	OK

General Provider Information

NPI Number	:	1245525021
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JON R GONZALEZ DO

Provider Business Mailing Address
First Line	:	2424 W PLEASANT RUN RD STE 200
Second Line	:
City	:	LANCASTER
State	:	TX
Zip	:	75146-4007
Country	:	US
Telephone Number	:	972-274-5200
Fax Number	:	972-274-5217

Provider Business Practice Location Address
First Line	:	2424 W PLEASANT RUN RD STE 200
Second Line	:
City	:	LANCASTER
State	:	TX
Zip	:	75146-4007
Country	:	US
Telephone Number	:	972-274-5200
Fax Number	:	972-274-5217

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

Provider Enumeration Date	:	06/09/2011
Last Update Date	:	04/27/2021

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