Provider Demographics
NPI:1639276520
Name:GONZALEZ, LUIS L JR (MD)
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:L
Last Name:GONZALEZ
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 28757
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-0162
Mailing Address - Country:US
Mailing Address - Phone:602-770-2468
Mailing Address - Fax:480-409-2512
Practice Address - Street 1:8300 E DIXILETA DR
Practice Address - Street 2:#278
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85266-2273
Practice Address - Country:US
Practice Address - Phone:602-770-2468
Practice Address - Fax:480-409-2512
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ15447207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZD43982Medicare UPIN
AZZ101443Medicare PIN