Provider Demographics
NPI:1639269913
Name:GONZALEZ GARCIA, RENE (MD)
Entity type:Individual
Prefix:
First Name:RENE
Middle Name:
Last Name:GONZALEZ GARCIA
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:PO BOX 90182
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89009-0182
Mailing Address - Country:US
Mailing Address - Phone:928-293-5999
Mailing Address - Fax:
Practice Address - Street 1:1957 HWAY 95 STE 23
Practice Address - Street 2:
Practice Address - City:BULLHEAD CITY
Practice Address - State:AZ
Practice Address - Zip Code:86442-6744
Practice Address - Country:US
Practice Address - Phone:928-234-3834
Practice Address - Fax:602-792-7270
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-15
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR587171100000X
MI4301117103207Q00000X, 208D00000X
PR15953208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No171100000XOther Service ProvidersAcupuncturist
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRDJ664AOtherMEDICARE
PRI-43979Medicare UPIN