Individual
ALFONSO GONZALEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3600 FOREST DR STE 400, COLUMBIA, SC 29204-4057
(803) 779-7316
(803) 343-2538
Mailing address
3600 FOREST DR STE 400, COLUMBIA, SC 29204-4057
(803) 779-7316
(803) 343-2538
Taxonomy
Speciality
Code
Description
License number
State
207ND0900X
Dermatopathology Physician
Primary
17121
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
070017292
RAILROAD MEDICARE
SC
05
—
171217
—
SC
Enumeration date
02/14/2006
Last updated
05/29/2019
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