Healthcare Provider Details

I. General information

NPI: 1417152331
Provider Name (Legal Business Name): RONALD M GONZALEZ DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2007
Last Update Date: 07/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 ELMWOOD AVE, BOX 665
ROCHESTER NY
14642
US

IV. Provider business mailing address

601 ELMWOOD AVE, BOX 665
ROCHESTER NY
14642
US

V. Phone/Fax

Practice location:
  • Phone: 585-275-5321
  • Fax: 585-273-3297
Mailing address:
  • Phone: 585-275-5321
  • Fax: 585-273-3297

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number256994
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number256994
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: