Individual
MRS. CARMEN H GONZALEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2600 GREENBUSH ST, LAFAYETTE, IN 47904
(765) 448-8000
Mailing address
1200 W WHITE RIVER BLVD, MUNCIE, IN 47303-4988
(877) 668-5621
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
01082957A
IN
207W00000X
Ophthalmology Physician
25MA08330200
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0160211
—
NJ
05
—
300032069
—
IN
Enumeration date
10/25/2007
Last updated
02/02/2021
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