Provider Demographics
NPI:1609974922
Name:GONZALES, RUBEN BELISARIO (MD)
Entity Type:Individual
Prefix:DR
First Name:RUBEN
Middle Name:BELISARIO
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 1:3171 S 3RD PL
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47802-3785
Mailing Address - Country:US
Mailing Address - Phone:812-235-4000
Mailing Address - Fax:812-894-4204
Practice Address - Street 1:1361 FORT HARRISON RD
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47804-1203
Practice Address - Country:US
Practice Address - Phone:812-235-4000
Practice Address - Fax:812-235-4004
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01035596207R00000X
IN132700000X
IN01035596A208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No132700000XDietary & Nutritional Service ProvidersDietary Manager
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100326570Medicaid
IN607750AMedicare ID - Type Unspecified
IND93419Medicare UPIN