=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609974922
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RUBEN BELISARIO GONZALES M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/20/2006
-----------------------------------------------------
Last Update Date | 05/24/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1361 FORT HARRISON RD
-----------------------------------------------------
City | TERRE HAUTE
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47804-1203
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 812-235-4000
-----------------------------------------------------
Fax | 812-235-4004
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3171 S 3RD PL
-----------------------------------------------------
City | TERRE HAUTE
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47802-3785
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 812-235-4000
-----------------------------------------------------
Fax | 812-894-4204
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | 01035596
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 132700000X
-----------------------------------------------------
Taxonomy Name | Dietary Manager
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 208M00000X
-----------------------------------------------------
Taxonomy Name | Hospitalist Physician
-----------------------------------------------------
License Number | 01035596A
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------