Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 0101234796 | VA |
N | 111NI0900X | Internist | 0101234796 | VA |
N | 207RI0200X | Infectious Disease | 0101234796 | VA |
NPI | 1093805632 |
---|---|
Provider Name | Gonzalo Bearman |
First Address | Richmond, VA 23291-1734 |
Second Address | Richmond, VA 23298-5051 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/10/2006 |
Last Update Date | 22/05/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
010013038 | (05) | VA |
H91500 | (02) |