Provider Demographics
NPI:1326196718
Name:GONZALEZ, IRIS PATRICIA (MD)
Entity Type:Individual
Prefix:DR
First Name:IRIS
Middle Name:PATRICIA
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 SW 6TH AVE STE 505
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66603-3810
Mailing Address - Country:US
Mailing Address - Phone:785-608-3299
Mailing Address - Fax:785-783-4525
Practice Address - Street 1:112 SW 6TH AVE STE 505
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66603-3810
Practice Address - Country:US
Practice Address - Phone:785-608-3299
Practice Address - Fax:785-940-5941
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-27034207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS04-27034OtherLICENSE NO
FG2392796OtherDEA NUMBER
KSF70964Medicare UPIN