Provider Demographics
NPI:1720473473
Name:GONZALEZ, JASON ADAM (MD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:ADAM
Last Name:GONZALEZ
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 1:10211 ALM STREET
Mailing Address - Street 2:DUKE PRIMARY CARE AT BRIER CREEK INTERNAL MEDICINE/PEDS
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27617
Mailing Address - Country:US
Mailing Address - Phone:919-484-8345
Mailing Address - Fax:
Practice Address - Street 1:10211 ALM STREET
Practice Address - Street 2:DUKE PRIMARY CARE AT BRIER CREEK INTERNAL MEDICINE/PEDS
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27617
Practice Address - Country:US
Practice Address - Phone:919-484-8345
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-31
Last Update Date:2019-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH57025892208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics