MEDICARE: RONALD L GONZALES MD PLLC

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

General Provider Information

NPI Number	:	1154368439
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RONALD L GONZALES MD PLLC

Provider Business Mailing Address
First Line	:	1124 N SAGINAW ST
Second Line	:
City	:	SAINT CHARLES
State	:	MI
Zip	:	48655-1021
Country	:	US
Telephone Number	:	989-865-8270
Fax Number	:	989-865-8582

Provider Business Practice Location Address
First Line	:	1124 N SAGINAW ST
Second Line	:
City	:	SAINT CHARLES
State	:	MI
Zip	:	48655-1021
Country	:	US
Telephone Number	:	989-865-8270
Fax Number	:	989-865-8582

Authorized Official
Title or Position	:	OWNER
Name	:	RONALD GONZALES JR.
Credential	:	MD
Telephone Number	:	989-865-8270

Provider Enumeration Date	:	06/02/2006
Last Update Date	:	03/30/2021

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