Provider Demographics
NPI:1619171758
Name:TARA L GONZALES MD PA
Entity Type:Organization
Organization Name:TARA L GONZALES MD PA
Other - Org Name:ARBOR PEDIATRICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TARA
Authorized Official - Middle Name:L
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-477-5475
Mailing Address - Street 1:4220 N DAVIS HWY
Mailing Address - Street 2:SUITE 200, BLDG. A
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-2752
Mailing Address - Country:US
Mailing Address - Phone:850-477-5475
Mailing Address - Fax:850-477-8186
Practice Address - Street 1:4220 N DAVIS HWY
Practice Address - Street 2:SUITE 200, BLDG. A
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-2752
Practice Address - Country:US
Practice Address - Phone:850-477-5475
Practice Address - Fax:850-477-8186
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty