Healthcare Provider Details

I. General information

NPI: 1639276520
Provider Name (Legal Business Name): LUIS L GONZALEZ JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 01/30/2020
Certification Date: 01/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8300 E DIXILETA DR #278
SCOTTSDALE AZ
85266-2273
US

IV. Provider business mailing address

PO BOX 28757
SCOTTSDALE AZ
85255-0162
US

V. Phone/Fax

Practice location:
  • Phone: 602-770-2468
  • Fax: 480-409-2512
Mailing address:
  • Phone: 602-770-2468
  • Fax: 480-409-2512

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number15447
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: