Individual
J GAVIN GONZALEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4140 E BASELINE RD, STE 211, MESA, AZ 85206
(480) 273-8680
(480) 306-7683
Mailing address
4140 E BASELINE RD, STE 211, MESA, AZ 85206
(480) 273-8680
(480) 306-7683
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
26245
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
26245
AZ MEDICAL BOARD
AZ
Enumeration date
03/14/2006
Last updated
07/12/2012
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