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General NPI Number Information
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NPI Number | 1649614520
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Entity Type | Individual
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Provider Name | MARK GONZALEZ ETTEL M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/23/2013
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Last Update Date | 06/30/2023
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Provider Practice Location Address
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Address Line | 601 ELMWOOD AVENUE UNIVERSITY OF ROCHESTER MEDICAL CENTER,
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City | ROCHESTER
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State | NY
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Zip | 14642-0001
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Country | US
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Telephone | 585-275-3191
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Fax | 585-273-3637
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Provider Business Mailing Address
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Address Line | 601 ELMWOOD AVENUE, BOX 626 URMC
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City | ROCHESTER
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State | NY
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Zip | 14642-0001
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Country | US
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Telephone | 585-275-3191
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Fax | 585-273-3637
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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 | 207ZP0101X
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Taxonomy Name | Anatomic Pathology Physician
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License Number | 4301111405
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 207ZP0101X
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Taxonomy Name | Anatomic Pathology Physician
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License Number | 293012
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License Number State | NY
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Taxonomy #3
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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 |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number | 293012
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License Number State | NY
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