Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 242635 | NY |
N | 111NI0900X | Internist | 242635 | NY |
Y | 207RC0001X | Clinical Cardiac Electrophysiologist | DR.0052595 | CO |
NPI | 1245370204 |
---|---|
Provider Name | Dr. Jaime Eduardo Gonzalez |
First Address | Colorado Springs, CO 80909-5533 |
Second Address | Colorado Springs, CO 80909-5533 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/02/2007 |
Last Update Date | 05/05/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
424563YLB8 | (02) | CO |
98785036 | (05) | CO |