Healthcare Provider Details

I. General information

NPI: 1952397481
Provider Name (Legal Business Name): VINCENT GONZALEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2005
Last Update Date: 06/13/2023
Certification Date: 06/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 N PORTER AVE
NORMAN OK
73071-6404
US

IV. Provider business mailing address

PO BOX 269024
OKLAHOMA CITY OK
73126-9024
US

V. Phone/Fax

Practice location:
  • Phone: 405-307-1000
  • Fax:
Mailing address:
  • Phone: 866-321-8433
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number17090
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number17090
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: