=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851663280
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GONZALEZ & SCHEFFER LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/01/2012
-----------------------------------------------------
Last Update Date | 02/01/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 105 RUSSELL ST
-----------------------------------------------------
City | HAYTI
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63851-1300
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 573-359-2930
-----------------------------------------------------
Fax | 573-359-1304
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 544
-----------------------------------------------------
City | HAYTI
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63851-0544
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 573-359-2930
-----------------------------------------------------
Fax | 573-359-1304
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PARTNER
-----------------------------------------------------
Name | ARIEL GONZALEZ
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 812-675-7616
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------