Organization
RICHARD J GONG, MD PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RICHARD JOHN GONG M.D. (DOCTOR/OWNER)
(210) 654-0866
Entity
Organization
Contact information
Practice address
2455 NE LOOP 410, SUITE 245, SAN ANTONIO, TX 78217-5649
(210) 654-0866
(210) 654-8723
Mailing address
2455 NE LOOP 410, SUITE 245, SAN ANTONIO, TX 78217-5649
(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
05
—
032677901
—
TX
01
—
1346279189
NPI
TX
Enumeration date
12/09/2010
Last updated
12/09/2010
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