Provider Demographics
NPI:1568575389
Name:GONZALEZ, WILLIAM L (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:L
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4000 MITCHELLVILLE RD
Mailing Address - Street 2:SUITE B128
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20716-3104
Mailing Address - Country:US
Mailing Address - Phone:301-464-1192
Mailing Address - Fax:301-464-2864
Practice Address - Street 1:4000 MITCHELLVILLE RD
Practice Address - Street 2:SUITE B128
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20716-3104
Practice Address - Country:US
Practice Address - Phone:301-464-1192
Practice Address - Fax:301-464-2864
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2008-10-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD0016996207W00000X
VA0101044148207W00000X
DCMD9847207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD030231700Medicaid
MD179917C80Medicare ID - Type Unspecified
C62394Medicare UPIN