Provider Demographics
NPI:1720276330
Name:RONALD GOTANCO, PA
Entity Type:Organization
Organization Name:RONALD GOTANCO, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:E
Authorized Official - Last Name:GOTANCO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-477-2409
Mailing Address - Street 1:PO BOX 2018
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78297-2018
Mailing Address - Country:US
Mailing Address - Phone:210-477-2409
Mailing Address - Fax:210-477-0376
Practice Address - Street 1:1303 MCCULLOUGH AVE
Practice Address - Street 2:SUITE 222
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78212-5609
Practice Address - Country:US
Practice Address - Phone:210-477-2409
Practice Address - Fax:210-477-0376
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-09
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
00X886Medicare PIN