Provider Demographics
NPI:1952319279
Name:JAVIER G. GONZALEZ, MD PA
Entity Type:Organization
Organization Name:JAVIER G. GONZALEZ, MD PA
Other - Org Name:NORTH CENTRAL FAMILY PRACTIVE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAVIER
Authorized Official - Middle Name:G
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD PA
Authorized Official - Phone:210-494-7724
Mailing Address - Street 1:226 W BITTERS RD
Mailing Address - Street 2:100
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-2329
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 2:100
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-2329
Practice Address - Country:US
Practice Address - Phone:210-494-7724
Practice Address - Fax:210-494-8641
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-03
Last Update Date:2008-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ4648207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX130833007Medicaid
TX130833007Medicaid
TX00124QMedicare PIN