MEDICARE: DR. CARLOS R. GONZALES MD

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	207Q00000X	Family Medicine Physician	15471	AZ

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00376509	OTHER	AZ	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134197791
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CARLOS R. GONZALES MD

Provider Business Mailing Address
First Line	:	2701 E ELVIRA RD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85706-7124
Country	:	US
Telephone Number	:	520-281-1550
Fax Number	:	520-281-1112

Provider Business Practice Location Address
First Line	:	2701 E ELVIRA RD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85706-7124
Country	:	US
Telephone Number	:	520-281-1550
Fax Number	:	520-281-1112

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

Provider Enumeration Date	:	03/09/2006
Last Update Date	:	05/29/2008

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