Individual
MR. ANTONIO J GONZALES IV
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
454 ST MICHAELS DR STE 200, SANTA FE, NM 87505-7602
(505) 303-5000
Mailing address
PO BOX 26666, ALBUQEURQUE, NM 87125-6666
(505) 923-9770
(505) 923-5654
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD2020-0150
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1306379664
—
NM
Enumeration date
04/04/2017
Last updated
03/22/2022
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