Healthcare Provider Details

I. General information

NPI: 1669635785
Provider Name (Legal Business Name): MICHAEL RAYMUND C GONZALES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2008
Last Update Date: 07/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10085 DOUBLE R BLVD STE 310
RENO NV
89521-4832
US

IV. Provider business mailing address

850 HARVARD WAY
RENO NV
89502-2055
US

V. Phone/Fax

Practice location:
  • Phone: 775-982-7260
  • Fax: 775-982-7268
Mailing address:
  • Phone: 518-253-0772
  • Fax: 775-982-5496

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number21747
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number309848
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number0116019889
License Number StateVA
# 4
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number16309
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: