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General NPI Number Information
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NPI Number | 1386795474
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Entity Type | Individual
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Provider Name | RICHARD D GONZALES MD
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Gender | Male
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Dates
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Enumeration Date | 01/15/2007
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Last Update Date | 01/22/2024
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Provider Practice Location Address
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Address Line | 4012 UNIVERSITY DR NW
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City | HUNTSVILLE
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State | AL
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Zip | 35816-3002
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Country | US
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Telephone | 256-882-0000
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Fax |
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Provider Business Mailing Address
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Address Line | 601 S HARBOUR ISLAND BLVD STE 200
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City | TAMPA
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State | FL
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Zip | 33602-5925
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Country | US
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Telephone | 800-480-5243
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD.42239
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License Number State | AL
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