Provider Demographics
NPI:1548399199
Name:GONZALEZ, ROGELIO I (MDPA)
Entity Type:Individual
Prefix:DR
First Name:ROGELIO
Middle Name:I
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:MDPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:730 N MAIN AVE
Mailing Address - Street 2:SUITE 408
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78205-1152
Mailing Address - Country:US
Mailing Address - Phone:210-226-8155
Mailing Address - Fax:210-226-8455
Practice Address - Street 1:730 N MAIN AVE
Practice Address - Street 2:SUITE 408
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78205-1152
Practice Address - Country:US
Practice Address - Phone:210-226-8155
Practice Address - Fax:210-226-8455
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF4847208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX950843OtherAETNA
TX110676701Medicaid
TX826023914OtherRAILROAD MEDICARE
TX4388167OtherCIGNA
TX2287857OtherBLUE LINK ID
TX2287857OtherBLUE LINK ID
TX950843OtherAETNA