Provider Demographics
NPI:1427386234
Name:GARY S GOSSEN, M.D., P.A.
Entity Type:Organization
Organization Name:GARY S GOSSEN, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:M
Authorized Official - Last Name:RICE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:210-692-0088
Mailing Address - Street 1:4499 MEDICAL DR
Mailing Address - Street 2:STE 126
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3735
Mailing Address - Country:US
Mailing Address - Phone:210-692-0088
Mailing Address - Fax:210-692-0030
Practice Address - Street 1:4499 MEDICAL DR
Practice Address - Street 2:STE 126
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3735
Practice Address - Country:US
Practice Address - Phone:210-692-0088
Practice Address - Fax:210-692-0030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-07
Last Update Date:2010-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF4014207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXF4014OtherLICENSE NUMBER
TX0A5483OtherMEDICARE PTAN
TX1124091079OtherNPI TYPE 1
TXB23087Medicare UPIN