Individual
DR. GEORGE DANIEL GONZALEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
444 CLINCHFIELD STREET, SUITE 2900, KINGSPORT, TN 37660
(423) 245-6101
(423) 245-2396
Mailing address
444 CLINCHFIELD STREET, SUITE 2900, KINGSPORT, TN 37660
(423) 245-6101
(423) 245-2396
Taxonomy
Speciality
Code
Description
License number
State
2085R0204X
Vascular & Interventional Radiology Physician
MD19962
TN
208600000X
Surgery Physician
Primary
MD19962
TN
2086S0129X
Vascular Surgery Physician
MD19962
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
20043969
RAILROAD MEDICARE
TN
01
—
265295
ANTHEM BCBS VIRGINIA
VA
05
—
3046049
—
TN
01
—
3130863
BCBS TENNESSEE
TN
01
—
4656188
AETNA
—
01
—
7311095
VIRGINIA MEDICAID
VA
Enumeration date
07/19/2006
Last updated
03/10/2015
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