Provider Demographics
NPI:1912194838
Name:GONZALES, PHILIP MENDOZA (MD)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:MENDOZA
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 1:10503 TROTTERS POINTE DR APT 202
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40241-1286
Mailing Address - Country:US
Mailing Address - Phone:502-852-7041
Mailing Address - Fax:
Practice Address - Street 1:10503 TROTTERS POINTE DR APT 202
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40241-1286
Practice Address - Country:US
Practice Address - Phone:502-852-7041
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-25
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program