Provider Demographics
NPI:1356463962
Name:GONZALEZ INTERNAL MEDICINE ASSOCIATES, P.A.
Entity type:Organization
Organization Name:GONZALEZ INTERNAL MEDICINE ASSOCIATES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:MENDOZA
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:864-366-9938
Mailing Address - Street 1:901 W GREENWOOD ST
Mailing Address - Street 2:SUITE 6
Mailing Address - City:ABBEVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29620-5678
Mailing Address - Country:US
Mailing Address - Phone:864-366-9938
Mailing Address - Fax:864-366-0818
Practice Address - Street 1:901 W GREENWOOD ST
Practice Address - Street 2:SUITE 6
Practice Address - City:ABBEVILLE
Practice Address - State:SC
Practice Address - Zip Code:29620-5678
Practice Address - Country:US
Practice Address - Phone:864-366-9938
Practice Address - Fax:864-366-0818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty