Individual
DR. JOHN ANTHONY GONZABA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
1263 HOSPITAL DR NW STE 270, CORYDON, IN 47112-2178
(812) 738-4251
Mailing address
PO BOX 38, CORYDON, IN 47112-0038
(812) 738-4251
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
02002543A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000295497
ANTHEM
IN
05
—
200415240
—
IN
01
—
P00102949
RR MEDICARE
IN
Enumeration date
10/12/2005
Last updated
07/18/2022
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