MEDICARE: JAVIER ANTONIO 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	208000000X	Pediatrics Physician	K0045	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	K0045	OTHER	TX	LICENSE NUMBER

General Provider Information

NPI Number	:	1588657035
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAVIER ANTONIO GONZALEZ M.D

Provider Business Mailing Address
First Line	:	1509 1ST ST
Second Line	:
City	:	ROSENBERG
State	:	TX
Zip	:	77471-3305
Country	:	US
Telephone Number	:	832-451-9290
Fax Number	:	281-232-2361

Provider Business Practice Location Address
First Line	:	1509 1ST ST
Second Line	:
City	:	ROSENBERG
State	:	TX
Zip	:	77471-3305
Country	:	US
Telephone Number	:	832-451-9290
Fax Number	:	281-232-2361

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

Provider Enumeration Date	:	08/30/2005
Last Update Date	:	07/09/2007

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