Individual
DR. MARY BETH GONYO
Active
Individual
DR. MARY BETH GONYO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
35572
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000018515B
HUMANA
—
05
—
1649221441
—
WI
Enumeration date
05/15/2006
Last updated
11/19/2013
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