Organization
LUIS C GONZALEZ MD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LUIS CARLOS GONZALEZ MD (OWNER)
(814) 362-4345
Entity
Organization
Contact information
Practice address
181 INTERSTATE PKWY, BRADFORD, PA 16701-1041
(814) 362-4345
(814) 362-1178
Mailing address
181 INTERSTATE PKWY, BRADFORD, PA 16701-1041
(814) 362-4345
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
MD0549041
PA
363AS0400X
Surgical Physician Assistant
363AS0400X
PA
Other
Enumeration date
08/09/2010
Last updated
08/09/2010
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