Provider Demographics
NPI:1336336288
Name:GONZALEZ, JESUS MESA JR (PA-C)
Entity Type:Individual
Prefix:
First Name:JESUS
Middle Name:MESA
Last Name:GONZALEZ
Suffix:JR
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6912 FM 1488 RD
Mailing Address - Street 2:STE A
Mailing Address - City:MAGNOLIA
Mailing Address - State:TX
Mailing Address - Zip Code:77354-1527
Mailing Address - Country:US
Mailing Address - Phone:281-356-1945
Mailing Address - Fax:281-356-1978
Practice Address - Street 1:1510 HANNA VALLEY RD
Practice Address - Street 2:
Practice Address - City:GOLDTHWAITE
Practice Address - State:TX
Practice Address - Zip Code:76844-2533
Practice Address - Country:US
Practice Address - Phone:325-648-2263
Practice Address - Fax:325-648-6303
Is Sole Proprietor?:No
Enumeration Date:2007-09-25
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXPA04958363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPA04958OtherTEXAS MEDICAL BOARD