# CHARLES T GONSOWSKI MD PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1063422541
- **Authorized official:** CHARLES T GONSOWSKI M.D. (PRESIDENT)
- **Authorized official phone:** (541) 882-1540

## Contact information

- **Practice address:** 2865 DAGGETT AVE, KLAMATH FALLS, OR 97601-1106
- **Practice address phone:** (541) 882-6311
- **Mailing address:** PO BOX 1359, KLAMATH FALLS, OR 97601-0075
- **Mailing address phone:** (541) 882-1540
- **Mailing address fax:** (541) 882-2583

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207L00000X | Anesthesiology Physician | MD21155 | OR | Yes |

## Other

- **Enumeration date:** 08/08/2006
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 151265 | — | OR |