Provider Demographics
NPI:1346493285
Name:V. JOHN GONINO D.O, P.A.
Entity type:Organization
Organization Name:V. JOHN GONINO D.O, P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:V
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:GONINO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:469-402-2800
Mailing Address - Street 1:6720 HORIZON
Mailing Address - Street 2:
Mailing Address - City:HEATH
Mailing Address - State:TX
Mailing Address - Zip Code:75032-6273
Mailing Address - Country:US
Mailing Address - Phone:469-402-2800
Mailing Address - Fax:469-402-0348
Practice Address - Street 1:6720 HORIZON
Practice Address - Street 2:
Practice Address - City:HEATH
Practice Address - State:TX
Practice Address - Zip Code:75032-6273
Practice Address - Country:US
Practice Address - Phone:469-402-2800
Practice Address - Fax:469-402-0348
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-23
Last Update Date:2010-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ2032207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00Z847Medicare PIN
TXF45228Medicare UPIN