Provider Demographics
NPI:1982809042
Name:PARES, GONZALO F (MD)
Entity Type:Individual
Prefix:DR
First Name:GONZALO
Middle Name:F
Last Name:PARES
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 170158
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29301-0022
Mailing Address - Country:US
Mailing Address - Phone:864-574-8925
Mailing Address - Fax:864-574-8922
Practice Address - Street 1:243 E BLACKSTOCK RD STE 6
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29301-2653
Practice Address - Country:US
Practice Address - Phone:864-574-8925
Practice Address - Fax:864-574-8922
Is Sole Proprietor?:No
Enumeration Date:2007-06-19
Last Update Date:2012-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC178842084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCT19432Medicaid
P00137245OtherRAILROAD MEDICARE
SCT19432Medicaid