Healthcare Provider Details

I. General information

NPI: 1447440045
Provider Name (Legal Business Name): MANUEL E GONZALEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2007
Last Update Date: 04/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2710 RIFE MEDICAL LN
ROGERS AR
72758-1452
US

IV. Provider business mailing address

2710 RIFE MEDICAL LN
ROGERS AR
72758-1452
US

V. Phone/Fax

Practice location:
  • Phone: 479-338-8000
  • Fax: 479-338-2906
Mailing address:
  • Phone: 479-338-8000
  • Fax: 479-338-2906

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberE-7087
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License NumberE-7087
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: