Provider Demographics
NPI:1245525021
Name:GONZALEZ, JON R (DO)
Entity type:Individual
Prefix:
First Name:JON
Middle Name:R
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2424 W PLEASANT RUN RD STE 200
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:TX
Mailing Address - Zip Code:75146-4007
Mailing Address - Country:US
Mailing Address - Phone:972-274-5200
Mailing Address - Fax:972-274-5217
Practice Address - Street 1:2424 W PLEASANT RUN RD STE 200
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:TX
Practice Address - Zip Code:75146-4007
Practice Address - Country:US
Practice Address - Phone:972-274-5200
Practice Address - Fax:972-274-5217
Is Sole Proprietor?:No
Enumeration Date:2011-06-09
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5217207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine