MEDICARE: JOHN ANTHONY GONZALEZ M.D.

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	207VF0040X	Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician	12939R	LA
2	207V00000X	Obstetrics & Gynecology Physician	12939R	LA

Other Identifiers

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

General Provider Information

NPI Number	:	1861490542
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN ANTHONY GONZALEZ M.D.

Provider Business Mailing Address
First Line	:	3 DORIS CT
Second Line	:
City	:	CROWLEY
State	:	LA
Zip	:	70526-2363
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	527 ODD FELLOWS RD STE B
Second Line	:
City	:	CROWLEY
State	:	LA
Zip	:	70526-2208
Country	:	US
Telephone Number	:	337-785-2006
Fax Number	:	337-785-2016

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

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	06/19/2017

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