Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 4301089991 | MI |
N | 111NI0900X | Internist | 4301089991 | MI |
N | 207RG0100X | Gastroenterologist | 107128 | MN |
Y | 207RG0100X | Gastroenterologist | 51261 | TN |
N | 207RG0100X | Gastroenterologist | 56890 | MN |
NPI | 1043401086 |
---|---|
Provider Name | Humberto Cesar Gonzalez Gonzalez |
First Address | Memphis, TN 38148-0457 |
Second Address | Memphis, TN 38104-3415 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/08/2007 |
Last Update Date | 13/08/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
04122575 | (05) | MS |
206119001 | (05) | AR |
6025474 | BCBS (01) | TN |
Q008639 | (05) | TN |