Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207T00000X | Neurosurgeon | 25MA08778100 | NJ |
Y | 207T00000X | Neurosurgeon | D91181 | MD |
N | 207T00000X | Neurosurgeon | MD437666 | PA |
NPI | 1053591024 |
---|---|
Provider Name | Dr. Luis Fernando Gonzalez |
First Address | Baltimore, MD 21220-2004 |
Second Address | Baltimore, MD 21287-0010 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/11/2007 |
Last Update Date | 07/07/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0205613 | (05) | NJ |
102366468 | (05) | PA |