Provider Demographics
NPI:1932117652
Name:GONINO, VINCENT JOHN (DO)
Entity Type:Individual
Prefix:
First Name:VINCENT
Middle Name:JOHN
Last Name:GONINO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:V.
Other - Middle Name:JOHN
Other - Last Name:GONINO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:6720 HORIZON RD
Mailing Address - Street 2:
Mailing Address - City:HEATH
Mailing Address - State:TX
Mailing Address - Zip Code:75032-6273
Mailing Address - Country:US
Mailing Address - Phone:469-402-2800
Mailing Address - Fax:469-402-0348
Practice Address - Street 1:6720 HORIZON RD
Practice Address - Street 2:
Practice Address - City:HEATH
Practice Address - State:TX
Practice Address - Zip Code:75032-6273
Practice Address - Country:US
Practice Address - Phone:469-402-2800
Practice Address - Fax:469-402-0348
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2010-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ2032207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX123661405Medicaid
TX00U71SOtherBLUE CROSS BLUE SHIELD
TX8F9201Medicare PIN