Provider Demographics
NPI:1700857927
Name:GONZALEZ, JOHN J JR (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:J
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:PO BOX 928
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78294-0928
Mailing Address - Country:US
Mailing Address - Phone:210-651-0303
Mailing Address - Fax:210-651-0302
Practice Address - Street 1:8811 VILLAGE DR
Practice Address - Street 2:SUITE 300
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-5415
Practice Address - Country:US
Practice Address - Phone:210-651-0303
Practice Address - Fax:210-651-0302
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2012-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL2284208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX085170101Medicaid
TXI4075Medicare UPIN
TX085170101Medicaid