Provider Demographics
NPI:1770031783
Name:TEXAS OAKS ORTHOPAEDIC AND SPORTS MEDICINE INSTITUTE, P.A.
Entity Type:Organization
Organization Name:TEXAS OAKS ORTHOPAEDIC AND SPORTS MEDICINE INSTITUTE, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:M
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-753-2663
Mailing Address - Street 1:8299 FREDERICKSBURG RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3359
Mailing Address - Country:US
Mailing Address - Phone:210-753-2663
Mailing Address - Fax:210-617-7542
Practice Address - Street 1:8299 FREDERICKSBURG RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3359
Practice Address - Country:US
Practice Address - Phone:210-753-2663
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-19
Last Update Date:2019-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF6677207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX539091OtherGROUP MEDICARE PTAN
TX539093ZW7OtherIND. MEDICARE PTAN