Individual
MR. DOMINGO GONZALES JAVIER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1701 JEFFERSON ST, BLUEFIELD, WV 24701-1701
(304) 325-5755
(304) 323-1639
Mailing address
1701 JEFFERSON ST, BLUEFIELD, WV 24701-1701
(304) 325-5755
(304) 323-1639
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
10588
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0127512000
—
WV
01
—
0472131
UMWA FUNDS
—
01
—
062480
BC ANTHEM
VA
01
—
1022384
WORKERS COMP
WV
01
—
103541
BLACK LUNG
—
01
—
4454937
AETNA
—
01
—
7350431
VA MED ASSIS
VA
01
—
851945
MAMSI
—
01
—
V000267
CHAMPUS
—
Enumeration date
09/19/2006
Last updated
07/08/2007
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