Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | 12939R | LA |
N | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | 12939R | LA |
NPI | 1861490542 |
---|---|
Provider Name | John Anthony Gonzalez |
First Address | Crowley, LA 70526-2363 |
Second Address | Crowley, LA 70526-2208 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2005 |
Last Update Date | 19/06/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1555011 | (05) | LA |
G93170 | (02) | LA |