MEDICARE: DR. JUAN A. GONZALEZ 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	207R00000X	Internal Medicine Physician	H3056	TX

General Provider Information

NPI Number	:	1487620241
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JUAN A. GONZALEZ M.D.

Provider Business Mailing Address
First Line	:	2961 MOSSROCK
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78230-5119
Country	:	US
Telephone Number	:	210-731-4800
Fax Number	:	210-731-4810

Provider Business Practice Location Address
First Line	:	1920 SW MILITARY DR
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78221-1451
Country	:	US
Telephone Number	:	210-924-2337
Fax Number	:	210-923-2208

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

Provider Enumeration Date	:	02/23/2006
Last Update Date	:	02/06/2015

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