Provider Demographics
NPI:1538159496
Name:GONZALEZ, JOSE M (P A)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:M
Last Name:GONZALEZ
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Gender:M
Credentials:P A
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Other - Credentials:
Mailing Address - Street 1:2431 W MAIN ST
Mailing Address - Street 2:STE 1001
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36301-1217
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2431 W MAIN ST
Practice Address - Street 2:STE 1001
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36301-1217
Practice Address - Country:US
Practice Address - Phone:334-794-2825
Practice Address - Fax:334-793-5050
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2007-07-08
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
R38374Medicare UPIN