Provider Demographics
NPI:1265875603
Name:GONZALES-PRYOR, EVELINDA DOMINIQUE (MD)
Entity type:Individual
Prefix:DR
First Name:EVELINDA
Middle Name:DOMINIQUE
Last Name:GONZALES-PRYOR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:707 N ALVERNON WAY STE 101
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85711-1830
Mailing Address - Country:US
Mailing Address - Phone:520-694-8888
Mailing Address - Fax:520-694-1640
Practice Address - Street 1:707 N ALVERNON WAY STE 101
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-1830
Practice Address - Country:US
Practice Address - Phone:520-694-8888
Practice Address - Fax:520-694-1640
Is Sole Proprietor?:No
Enumeration Date:2013-04-16
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2016-0669207Q00000X
AZ54024207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM72727853Medicaid