Individual
RICHARD JOHN GONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2455 NE LOOP 410, STE 245, SAN ANTONIO, TX 78217
(210) 654-0866
(210) 654-8723
Mailing address
2455 NE LOOP 410, STE 245, SAN ANTONIO, TX 78217
(210) 654-0866
(210) 654-8723
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
G9105
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
032677901
TPI
TX
05
—
P000D68F8
—
TX
Enumeration date
07/02/2006
Last updated
07/27/2010
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