Provider Demographics
NPI:1164478145
Name:CATHRY J. GONZALES, M.D., P.A.
Entity Type:Organization
Organization Name:CATHRY J. GONZALES, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CATHRYN
Authorized Official - Middle Name:J
Authorized Official - Last Name:GONZALES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:870-235-1112
Mailing Address - Street 1:1327 N WASHINGTON
Mailing Address - Street 2:
Mailing Address - City:MAGNOLIA
Mailing Address - State:AR
Mailing Address - Zip Code:71753-2067
Mailing Address - Country:US
Mailing Address - Phone:870-235-1112
Mailing Address - Fax:870-235-1114
Practice Address - Street 1:1327 N WASHINGTON
Practice Address - Street 2:
Practice Address - City:MAGNOLIA
Practice Address - State:AR
Practice Address - Zip Code:71753-2067
Practice Address - Country:US
Practice Address - Phone:870-235-1112
Practice Address - Fax:870-235-1114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR04D1052359OtherCLIA
AR161249002Medicaid
AR5F523Medicare PIN