Individual
JASON THOMAS GONZALES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1100 LEAD AVE SE, PMG GI, ALBUQUERQUE, NM 87106-5215
(505) 224-7000
(505) 224-7292
Mailing address
PO BOX 26666, PHS PROVIDER ENROLLMENT, ALBUQUERQUE, NM 87125-6666
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA2005-0032
NM
Other
Enumeration date
02/08/2006
Last updated
06/02/2016
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