Provider Demographics
NPI:1033756382
Name:TEXAS OAKS ORTHOPAEDIC AND SPORTS MEDICINE INSTITUTE, P.A.
Entity Type:Organization
Organization Name:TEXAS OAKS ORTHOPAEDIC AND SPORTS MEDICINE INSTITUTE, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHOPAEDIC SURGEON / PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:M
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-753-2663
Mailing Address - Street 1:525 OAK CENTRE DR STE 140
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-3916
Mailing Address - Country:US
Mailing Address - Phone:210-753-2663
Mailing Address - Fax:210-617-7542
Practice Address - Street 1:525 OAK CENTRE DR STE 140
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-3916
Practice Address - Country:US
Practice Address - Phone:210-753-2663
Practice Address - Fax:210-617-7542
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-05
Last Update Date:2019-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1460768-03Medicaid