Provider Demographics
NPI:1700809365
Name:GONZALES, CHRISTINE READ (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:READ
Last Name:GONZALES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:246 CATALINA DRIVE
Mailing Address - Street 2:RETINA AND VITREOUS CENTER
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520
Mailing Address - Country:US
Mailing Address - Phone:541-488-3192
Mailing Address - Fax:541-488-0646
Practice Address - Street 1:246 CATALINA DR
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520-1624
Practice Address - Country:US
Practice Address - Phone:541-488-3192
Practice Address - Fax:541-488-0646
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2008-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA68646207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A686460OtherMEDICAL PPIN #
ORMD28374OtherOREGON STATE MEDICAL LICENSE
CAG98155Medicare UPIN