Provider Demographics
NPI:1689250771
Name:GONZALES, ANTONY (DO)
Entity Type:Individual
Prefix:
First Name:ANTONY
Middle Name:
Last Name:GONZALES
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 HARRISON AVE STE 914
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-2334
Mailing Address - Country:US
Mailing Address - Phone:617-638-8540
Mailing Address - Fax:617-638-8542
Practice Address - Street 1:720 HARRISON AVE STE 914
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-2334
Practice Address - Country:US
Practice Address - Phone:617-638-8540
Practice Address - Fax:617-638-8542
Is Sole Proprietor?:No
Enumeration Date:2021-03-20
Last Update Date:2021-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program