Provider Demographics
NPI:1295793149
Name:ASENSIO-GONZALEZ, JUAN A (MD, FACS, FCCM, FR)
Entity type:Individual
Prefix:DR
First Name:JUAN
Middle Name:A
Last Name:ASENSIO-GONZALEZ
Suffix:
Gender:M
Credentials:MD, FACS, FCCM, FR
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Other - Last Name:
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Mailing Address - Street 1:920 DOUG WHITE DR STE 210
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29572-4181
Mailing Address - Country:US
Mailing Address - Phone:843-497-6348
Mailing Address - Fax:843-497-6351
Practice Address - Street 1:920 DOUG WHITE DR STE 210
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29572-4181
Practice Address - Country:US
Practice Address - Phone:843-497-6348
Practice Address - Fax:843-497-6351
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA724442086S0102X
NY2645012086S0127X
NE281472086S0127X
FLME955042086S0127X
SC912242086S0127X, 2086S0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01168327Medicaid
NYA400065282Medicare PIN