Healthcare Provider Details

I. General information

NPI: 1619163649
Provider Name (Legal Business Name): VICTOR JOSE GONZALEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2007
Last Update Date: 03/18/2022
Certification Date: 03/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 N CAMPBELL AVE DEPT. OF RADIATION ONCOLOGY
TUCSON AZ
85724-5081
US

IV. Provider business mailing address

1115 SE 164TH AVE DEPT 358
VANCOUVER WA
98683-8004
US

V. Phone/Fax

Practice location:
  • Phone: 520-694-7236
  • Fax:
Mailing address:
  • Phone: 360-729-1412
  • Fax: 360-729-3025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberMD61259560
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number6359017-1205
License Number StateUT
# 3
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number43282
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: