Provider Demographics
NPI:1245529767
Name:JONNA, GOWTHAM (MD)
Entity type:Individual
Prefix:
First Name:GOWTHAM
Middle Name:
Last Name:JONNA
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3705 MEDICAL PKWY STE 460
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705-1024
Mailing Address - Country:US
Mailing Address - Phone:512-454-5851
Mailing Address - Fax:512-454-5853
Practice Address - Street 1:3705 MEDICAL PKWY STE 460
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-1024
Practice Address - Country:US
Practice Address - Phone:512-454-5851
Practice Address - Fax:512-454-5853
Is Sole Proprietor?:No
Enumeration Date:2011-04-05
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR1552207WX0107X
390200000X
TNR1552207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program