Individual
DR. JED DAVID GONZALO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3 RIVERSIDE CIR, ROANOKE, VA 24016-4955
(540) 224-5170
Mailing address
213 S JEFFERSON ST STE 1006, ROANOKE, VA 24011-1713
(540) 224-5352
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
0101277337
VA
207R00000X
Internal Medicine Physician
228391
MA
207R00000X
Internal Medicine Physician
MD436675
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1023683370003
—
PA
Enumeration date
05/21/2008
Last updated
12/28/2022
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