Healthcare Provider Details

I. General information

NPI: 1841983517
Provider Name (Legal Business Name): EVAN GONZALEZ PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/30/2023
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1031 CARE WAY
FREDERICKSBURG VA
22401-8425
US

IV. Provider business mailing address

PO BOX 419669
BOSTON MA
02241-9669
US

V. Phone/Fax

Practice location:
  • Phone: 540-371-7600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: