Provider Demographics
NPI:1528010212
Name:GONZALEZ, JAVIER G (MD PA)
Entity Type:Individual
Prefix:DR
First Name:JAVIER
Middle Name:G
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:MD PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:226 W BITTERS RD
Mailing Address - Street 2:STE 100
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-2072
Mailing Address - Country:US
Mailing Address - Phone:210-494-7724
Mailing Address - Fax:210-494-8641
Practice Address - Street 1:226 W BITTERS RD
Practice Address - Street 2:STE 100
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-2072
Practice Address - Country:US
Practice Address - Phone:210-494-7724
Practice Address - Fax:210-494-8641
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2008-11-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXJ4648207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX130833007Medicaid
TX00124QMedicare ID - Type Unspecified
TXF67193Medicare UPIN