Provider Demographics
NPI:1447207402
Name:GONZALES, JOHN MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:MICHAEL
Last Name:GONZALES
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 1:100-C ALBRIGHT WAY
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95032-1837
Mailing Address - Country:US
Mailing Address - Phone:408-866-5227
Mailing Address - Fax:408-866-5228
Practice Address - Street 1:100-C ALBRIGHT WAY
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95032-1837
Practice Address - Country:US
Practice Address - Phone:408-866-5227
Practice Address - Fax:408-866-5228
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2010-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG56012207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALAB58234GMedicaid
CALAB58234GMedicaid
CAZZZ33972ZMedicare PIN
CAE73342Medicare UPIN