Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207L00000X | Anesthesiologist | 0101262432 | VA |
Y | 207L00000X | Anesthesiologist | 01049228A | IN |
N | 207L00000X | Anesthesiologist | 336.060457 | IL |
N | 207L00000X | Anesthesiologist | P2119 | TX |
N | 207N00000X | Dermatologist | 2017-01463 | NC |
NPI | 1053365932 |
---|---|
Provider Name | Dr. Jorge A Gonzalez |
First Address | Schererville, IN 46375-1488 |
Second Address | Schererville, IN 46375-1488 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2006 |
Last Update Date | 21/05/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000280445 | ANTHEM (01) | IN |
1053365932 | NPI (01) | |
200411250A | (05) | IL |
336-060457 | ILLINOIS STATE (01) | IL |
H20208 | (02) |