MEDICARE: DR. GONZALO A. AILLON II D.O.

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	L2781	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	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1598790644
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GONZALO A. AILLON II D.O.

Provider Business Mailing Address
First Line	:	1138 BRADLEY DR
Second Line	:
City	:	DUNCANVILLE
State	:	TX
Zip	:	75137-4224
Country	:	US
Telephone Number	:	214-536-3355
Fax Number	:	972-572-2258

Provider Business Practice Location Address
First Line	:	1401 S RANGERVILLE RD
Second Line	:
City	:	HARLINGEN
State	:	TX
Zip	:	78552-7638
Country	:	US
Telephone Number	:	956-430-2408
Fax Number	:

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

Provider Enumeration Date	:	07/11/2006
Last Update Date	:	10/08/2019

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Directions to “ DR. GONZALO A. AILLON II D.O.” Practice Location

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