Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080N0001X | Neonatal-Perinatal Doctor | 036-068698 | IL |
NPI | 1043320237 |
---|---|
Provider Name | Jose L. Gonzalez |
First Address | Rockford, IL 61103-3655 |
Second Address | Rockford, IL 61103-3655 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2006 |
Last Update Date | 26/01/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036068698 | (05) | IL |
F37518 | (02) | IL |