Individual
PHILLIP J GONZALES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
8325 CITY CENTRE DR, WOODBURY, MN 55125-3605
(651) 731-0859
(651) 731-0976
Mailing address
2025 SLOAN PL STE 35, SAINT PAUL, MN 55117-2092
(651) 772-1572
(651) 772-1889
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
30345
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
114383200
—
MN
Enumeration date
08/02/2006
Last updated
04/22/2019
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