Individual
DR. FERNANDO LUIS GONZALEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
611 W PARK ST, URBANA, IL 61801
(217) 383-3311
Mailing address
611 W. PARK ST., FAPC, URBANA, IL 61801-5045
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
01060971A
IN
208800000X
Urology Physician
Primary
036-083284
IL
208800000X
Urology Physician
MD2012-0231
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200527960
—
IN
Enumeration date
10/28/2005
Last updated
12/15/2022
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