Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | 4301042712 | MI |
NPI | 1245287523 |
---|---|
Provider Name | Raymond Gonzalez |
First Address | Grand Rapids, MI 49503-2560 |
Second Address | Grand Rapids, MI 49525-9477 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/05/2006 |
Last Update Date | 16/03/2015 |