Provider Demographics
NPI:1215119722
Name:GONZALES, JOHN PATRICK (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:PATRICK
Last Name:GONZALES
Suffix:
Gender:M
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:701 N MAIN ST
Mailing Address - Street 2:STE. B
Mailing Address - City:DONNA
Mailing Address - State:TX
Mailing Address - Zip Code:78537-2765
Mailing Address - Country:US
Mailing Address - Phone:956-464-3649
Mailing Address - Fax:956-464-3670
Practice Address - Street 1:701 N MAIN ST
Practice Address - Street 2:STE. B
Practice Address - City:DONNA
Practice Address - State:TX
Practice Address - Zip Code:78537-2765
Practice Address - Country:US
Practice Address - Phone:956-464-3649
Practice Address - Fax:956-464-3670
Is Sole Proprietor?:No
Enumeration Date:2007-11-27
Last Update Date:2011-11-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXPA03770363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant