Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 0101022930 | VA |
NPI | 1013975101 |
---|---|
Provider Name | Dr. George Tendero Gonzales |
First Address | Fredericksburg, VA 22401 |
Second Address | Fredericksburg, VA 22401 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/05/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B09409 | (02) |