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Individual

MRS. JENNIFER W GONZALEZ

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA

Contact information

Practice address
725 UNIVERSITY BLVD, BEAVERCREEK, OH 45324-2640
(937) 245-7200
(937) 245-7999
Mailing address
725 UNIVERSITY BLVD, BEAVERCREEK, OH 45324-2640
(937) 245-7200
(937) 245-7999

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
50.007105RX
OH
363A00000X
Physician Assistant
PA9112057
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0462499
OH
01
0EJPX
BLUE CROSS BLUE SHIELD
FL
05
104159800
FL
Enumeration date
10/14/2007
Last updated
09/21/2022
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