Provider Demographics
NPI:1104910017
Name:GURMENDI, GONZALO GABRIEL (MD)
Entity type:Individual
Prefix:DR
First Name:GONZALO
Middle Name:GABRIEL
Last Name:GURMENDI
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 1:1736 OXMOOR RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35209-4058
Mailing Address - Country:US
Mailing Address - Phone:205-879-2120
Mailing Address - Fax:205-879-2125
Practice Address - Street 1:1736 OXMOOR RD
Practice Address - Street 2:SUITE 103
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35209-4058
Practice Address - Country:US
Practice Address - Phone:205-879-2120
Practice Address - Fax:205-879-2125
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL132282084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL510-79296OtherBLUE CROSS/BLUE SHIELD
ALC75798Medicare UPIN