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General NPI Number Information
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NPI Number | 1659341998
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Entity Type | Individual
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Provider Name | LUIS GUSTAVO GONZALEZ MD
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Gender | Male
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Dates
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Enumeration Date | 01/26/2006
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Last Update Date | 06/04/2008
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Provider Practice Location Address
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Address Line | 618 S MAIN ST ANESTHESIA DEPT
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City | REIDSVILLE
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State | NC
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Zip | 27320-5020
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Country | US
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Telephone | 336-951-1010
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2627
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City | REIDSVILLE
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State | NC
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Zip | 27323-2627
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Country | US
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Telephone | 336-951-1010
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 000031135
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License Number State | NC
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