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General NPI Number Information
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NPI Number | 1548721616
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Entity Type | Individual
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Provider Name | FRED PETE GONZALES III MD
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Gender | Male
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Dates
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Enumeration Date | 03/29/2019
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Last Update Date | 07/24/2024
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Provider Practice Location Address
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Address Line | 2123 AUBURN AVE STE 724
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City | CINCINNATI
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State | OH
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Zip | 45219-2906
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Country | US
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Telephone | 513-241-4774
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Fax |
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Provider Business Mailing Address
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Address Line | 2139 AUBURN AVE # 4-7
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City | CINCINNATI
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State | OH
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Zip | 45219-2906
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Country | US
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Telephone | 513-558-7651
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Fax | 513-558-7622
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | 57.249175
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 35.151147
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License Number State | OH
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