MEDICARE: DR. JOSHUA TYLER JOSEPH GONZALES DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	207R00000X	Internal Medicine Physician	11022533A	IN
3	208M00000X	Hospitalist Physician	DO.OP.61643290	WA

General Provider Information

NPI Number	:	1053989970
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSHUA TYLER JOSEPH GONZALES DO

Provider Business Mailing Address
First Line	:	DEPARTMENT OF GRADUATE MEDICAL EDUCATION
Second Line	:	635 BARNHILL DRIVE
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46202
Country	:	US
Telephone Number	:	317-274-8282
Fax Number	:

Provider Business Practice Location Address
First Line	:	801 SAINT MARYS DR STE 510
Second Line	:
City	:	EVANSVILLE
State	:	IN
Zip	:	47714-0511
Country	:	US
Telephone Number	:	812-485-4422
Fax Number	:	201-603-6684

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/16/2021
Last Update Date	:	06/10/2026

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