Organization
CHARLES T GONSOWSKI MD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLES T GONSOWSKI M.D. (PRESIDENT)
(541) 882-1540
Entity
Organization
Contact information
Practice address
2865 DAGGETT AVE, KLAMATH FALLS, OR 97601-1106
(541) 882-6311
Mailing address
PO BOX 1359, KLAMATH FALLS, OR 97601-0075
(541) 882-1540
(541) 882-2583
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
MD21155
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
151265
—
OR
Enumeration date
08/08/2006
Last updated
08/22/2020
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