Organization
SERGIO G GONZALEZ MD PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SERGIO G GONZALEZ MD (DIRECTOR)
(601) 649-5842
Entity
Organization
Contact information
Practice address
119 SOUTH 12TH AVENUE, LAUREL, MS 39440-4322
(601) 425-9763
(601) 428-5360
Mailing address
119 SOUTH 12TH AVENUE, LAUREL, MS 39440-4322
(601) 425-9763
(601) 428-5360
Taxonomy
Speciality
Code
Description
License number
State
207ZD0900X
Dermatopathology (Pathology) Physician
Primary
6914
MS
208D00000X
General Practice Physician
06914
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00013124
—
MS
01
—
512G70024
MEDICARE GROUP
MS
Enumeration date
06/21/2005
Last updated
01/24/2008
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