MEDICARE: JAVIER G. GONZALEZ, MD PA

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	J4648	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

General Provider Information

NPI Number	:	1952319279
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JAVIER G. GONZALEZ, MD PA

Provider Business Mailing Address
First Line	:	226 W BITTERS RD
Second Line	:	100
City	:	SAN ANTONIO
State	:	TX
Zip	:	78216-2329
Country	:	US
Telephone Number	:	210-494-7724
Fax Number	:	210-494-8641

Provider Business Practice Location Address
First Line	:	226 W BITTERS RD
Second Line	:	100
City	:	SAN ANTONIO
State	:	TX
Zip	:	78216-2329
Country	:	US
Telephone Number	:	210-494-7724
Fax Number	:	210-494-8641

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JAVIER G GONZALEZ
Credential	:	MD PA
Telephone Number	:	210-494-7724

Provider Enumeration Date	:	08/03/2006
Last Update Date	:	12/02/2008

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