Provider Demographics
NPI:1558406637
Name:GONZALES, EUGENE ADRIAN (MD)
Entity Type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:ADRIAN
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 1:1905 E. HUEBBE PARKWAY
Mailing Address - Street 2:BELOIT HEALTH SYSTEM INC
Mailing Address - City:BELOIT
Mailing Address - State:WI
Mailing Address - Zip Code:53511-1842
Mailing Address - Country:US
Mailing Address - Phone:608-363-9557
Mailing Address - Fax:
Practice Address - Street 1:1735 MADISON RD
Practice Address - Street 2:
Practice Address - City:BELOIT
Practice Address - State:WI
Practice Address - Zip Code:53511-3216
Practice Address - Country:US
Practice Address - Phone:608-363-7510
Practice Address - Fax:608-363-7528
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2011-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI36841207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI321584000Medicaid
D24487Medicare UPIN
WI321584000Medicaid