Organization
CHAD M GONZALES MD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHAD M GONZALES M.D. (OWNER)
(801) 387-2550
Entity
Organization
Contact information
Practice address
4403 HARRISON BLVD, SUITE 2855, OGDEN, UT 84403-3271
(801) 387-2550
(801) 387-2555
Mailing address
4403 HARRISON BLVD, SUITE 2855, OGDEN, UT 84403-3271
(801) 387-2550
(801) 387-2555
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
4825699-1205
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DD5804
RAILROAD MEDICARE
UT
Enumeration date
03/09/2007
Last updated
10/30/2007
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