Individual
MARK GONWA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1500 N DIXIE HWAY, STE 306, WEST PALM BEACH, FL 33401
(561) 837-4834
(561) 837-2225
Mailing address
68 MONTEREY POINT DR, PALM BEACH GARDENS, FL 33418
(561) 670-5215
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
ME64311
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000545011
ANTHEM BCBS
KY
05
—
378003100
—
FL
05
—
7100037330
—
KY
Enumeration date
12/04/2006
Last updated
03/07/2023
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