| Doctor Name: | DR. MARS BALDOZA GONZAGA |
| NPI Number: | 1427021773 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MD |
| License Number: | 11062 |
| Business Practice Address: | 505 W 2nd St Drumright, OK - 740304424 |
| Business Phone Number: | 9183529565 |
| Business Fax Number: | 9183522180 |
| Mailing Address: | Po Box 1237, DRIMRIGHT |
| State: | OK |
| Postal Code: | 740304424 |
| Phone Number: | 9183529565 |
| Fax Number: | 9183522180 |
| NPI Enumeration Date: | 02/08/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 11062 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OK |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |