=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861490542
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOHN ANTHONY GONZALEZ M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/07/2005
-----------------------------------------------------
Last Update Date | 06/19/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 527 ODD FELLOWS RD STE B
-----------------------------------------------------
City | CROWLEY
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70526-2208
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 337-785-2006
-----------------------------------------------------
Fax | 337-785-2016
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3 DORIS CT
-----------------------------------------------------
City | CROWLEY
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70526-2363
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207VF0040X
-----------------------------------------------------
Taxonomy Name | Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
-----------------------------------------------------
License Number | 12939R
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number | 12939R
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------