Provider Demographics
NPI:1376549204
Name:GONZALEZ, FILOMENO P JR (MD)
Entity Type:Individual
Prefix:DR
First Name:FILOMENO
Middle Name:P
Last Name:GONZALEZ
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 NAVARRO ST STE 600
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78205-1892
Mailing Address - Country:US
Mailing Address - Phone:844-630-0700
Mailing Address - Fax:
Practice Address - Street 1:1860 S SEGUIN AVE
Practice Address - Street 2:BLDG E.
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-3914
Practice Address - Country:US
Practice Address - Phone:830-626-7770
Practice Address - Fax:855-278-4535
Is Sole Proprietor?:No
Enumeration Date:2005-06-24
Last Update Date:2018-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM0737207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX201629703Medicaid
TXM0737OtherTX LICENSE
TXP01430405OtherRR MEDICARE
TX201629703Medicaid