Individual
SERGIO GONZALEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
1011 14TH AVE NW, ARDMORE, OK 73401-1828
(580) 226-1251
(580) 226-1254
Mailing address
1011 14TH AVE NW, ARDMORE, OK 73401-1828
(580) 226-1251
(580) 226-1254
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
R0075019
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
R0075019
CRNA LICENSE
OK
Enumeration date
01/21/2010
Last updated
01/21/2010
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