Provider Demographics
NPI:1134309479
Name:GONZALEZ, OSCAR IBANEZ (MD)
Entity Type:Individual
Prefix:DR
First Name:OSCAR
Middle Name:IBANEZ
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12333 NE 130TH LANE
Mailing Address - Street 2:EVERGREEN HEALTH STE 320
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-3039
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12333 NE 130TH LANE
Practice Address - Street 2:STE 320
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-3039
Practice Address - Country:US
Practice Address - Phone:425-899-0555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-04
Last Update Date:2014-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00000000207R00000X
WA0000000207R00000X
WAMD60152903207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine