Provider Demographics
NPI:1861522849
Name:GONZALEZ, NESTOR RUBEN (MD)
Entity type:Individual
Prefix:
First Name:NESTOR
Middle Name:RUBEN
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 N LORETTO RD
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:KY
Mailing Address - Zip Code:40033-1300
Mailing Address - Country:US
Mailing Address - Phone:270-692-3161
Mailing Address - Fax:270-692-5155
Practice Address - Street 1:111 WELL PARK LANE
Practice Address - Street 2:STE 1
Practice Address - City:CAMPBELLSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42718
Practice Address - Country:US
Practice Address - Phone:270-692-3161
Practice Address - Fax:270-692-5155
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN11011414A390200000X
KYFT335390200000X
KY43819207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program