Provider Demographics
NPI:1649259920
Name:GAONA, RAUL E JR
Entity type:Individual
Prefix:DR
First Name:RAUL
Middle Name:E
Last Name:GAONA
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:414 NAVARRO ST
Mailing Address - Street 2:SUITE 1030
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78205-2516
Mailing Address - Country:US
Mailing Address - Phone:210-225-1471
Mailing Address - Fax:210-225-7623
Practice Address - Street 1:414 NAVARRO ST
Practice Address - Street 2:SUITE 1030
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78205-2516
Practice Address - Country:US
Practice Address - Phone:210-225-1471
Practice Address - Fax:210-225-7623
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-13
Last Update Date:2010-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXTXK1444207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX038271502Medicaid
TXG33735Medicare UPIN
TX0030ARMedicare ID - Type UnspecifiedMEDICARE ID
TX038271502Medicaid