Healthcare Provider Details

I. General information

NPI: 1083687479
Provider Name (Legal Business Name): CONRADO C GONZALEZ JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2006
Last Update Date: 04/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6105 HEALTH CENTER LANE
FREDERICKSBURG VA
22407
US

IV. Provider business mailing address

PO BOX 31872
RICHMOND VA
23294-1872
US

V. Phone/Fax

Practice location:
  • Phone: 540-786-5262
  • Fax: 540-786-5299
Mailing address:
  • Phone: 804-266-8717
  • Fax: 804-266-5677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number0101030838
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: