Individual
LUIS F GONZALEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
133 FAIRFIELD ST, ST ALBANS, VT 05478-1726
(802) 524-1058
(802) 524-1289
Mailing address
PO BOX 846170, BOSTON, MA 02284-6170
(802) 524-1058
(802) 524-1289
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
042-0009728
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0VN1883
—
VT
01
—
300123221
RAILROAD MEDICARE
VT
Enumeration date
05/25/2006
Last updated
05/17/2011
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