MEDICARE: GONZALEZ MEDICAL OFFICES, LLP

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	207R00000X	Internal Medicine Physician	D0056791	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	185839	OTHER	MD	PTAN

General Provider Information

NPI Number	:	1720228463
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GONZALEZ MEDICAL OFFICES, LLP

Provider Business Mailing Address
First Line	:	2311 ARCOLA AVE
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20902-2826
Country	:	US
Telephone Number	:	301-933-6644
Fax Number	:	301-933-6647

Provider Business Practice Location Address
First Line	:	2311 ARCOLA AVE
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20902-2826
Country	:	US
Telephone Number	:	301-933-6644
Fax Number	:	301-933-6647

Authorized Official
Title or Position	:	PROVIDER
Name	:	DR. LUIS ANTONIO GONZALEZ
Credential	:	M.D.
Telephone Number	:	301-933-6644

Provider Enumeration Date	:	02/20/2009
Last Update Date	:	02/15/2011

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Directions to “GONZALEZ MEDICAL OFFICES, LLP ” Practice Location

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