Provider Demographics
NPI:1851471163
Name:GONZALEZ, JOHN WINSTON DONATO (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN WINSTON
Middle Name:DONATO
Last Name:GONZALEZ
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 1:501 E HOSPITAL LN
Mailing Address - Street 2:SUITE 104
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47802-4230
Mailing Address - Country:US
Mailing Address - Phone:812-232-5518
Mailing Address - Fax:812-235-8908
Practice Address - Street 1:501 E HOSPITAL LN
Practice Address - Street 2:SUITE 104
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47802-4230
Practice Address - Country:US
Practice Address - Phone:812-232-5518
Practice Address - Fax:812-235-8908
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN010452632084P0800X
IN01052463A2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200289950Medicaid
IN161250Medicare ID - Type UnspecifiedMEDICARE NO.