Doctor Name: | MR. FLORIE GONZALES |
NPI Number: | 1003823360 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | OTR/L, CHT |
License Number: | KY-R2223 |
Business Practice Address: | 3851 Roger Brooke Dr Fort Sam Houston, TX - 782344501 |
Business Phone Number: | 2109165808 |
Business Fax Number: | 2109168161 |
Mailing Address: | 19275 Stone Oak Pkwy, Apt. 713 SAN ANTONIO |
State: | TX |
Postal Code: | 782583289 |
Phone Number: | 2103329455 |
Fax Number: | |
NPI Enumeration Date: | 08/01/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 171000000X |
License Number: | KY-R2223 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | KY |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Military Health Care Provider |
Taxonomy Specialization: | |
Taxonomy Definition: | Active duty military health care providers not otherwise classified who need to be separately identified for operational, clinical, or administrative processes. |