Provider Demographics
NPI:1477553865
Name:GONZALEZ-TRAPAGA, JUSTO (MD)
Entity Type:Individual
Prefix:DR
First Name:JUSTO
Middle Name:
Last Name:GONZALEZ-TRAPAGA
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 1:1005 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:IL
Mailing Address - Zip Code:62301-2834
Mailing Address - Country:US
Mailing Address - Phone:217-223-8400
Mailing Address - Fax:217-277-3960
Practice Address - Street 1:927 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:IL
Practice Address - Zip Code:62301-2719
Practice Address - Country:US
Practice Address - Phone:217-214-6261
Practice Address - Fax:217-228-2390
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2022014600207RN0300X
IAMD-49740207RN0300X
IL036160186207RN0300X
GA077267207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRF96617Medicare UPIN
PR89043Medicare ID - Type Unspecified