| Organization Name: | SERGIO G GONZALEZ MD PA |
| NPI Number: | 1952307308 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | SERGIO G GONZALEZ (DIRECTOR) |
| Mailing Address: | 119 South 12th Avenue Laurel |
| State: | MS US |
| Postal Code: | 394404322 |
| Phone Number: | 6014259763 |
| Fax Number: | 6014285360 |
| NPI Enumeration Date: | 06/21/2005 |
| NPI Last Update Date: | 01/24/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 06914 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | MS |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |