Provider Demographics
NPI:1366425886
Name:CELIS, GONZALO M (MD)
Entity type:Individual
Prefix:DR
First Name:GONZALO
Middle Name:M
Last Name:CELIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2202 N FORBES BLVD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85745-1412
Mailing Address - Country:US
Mailing Address - Phone:520-622-5912
Mailing Address - Fax:520-791-2246
Practice Address - Street 1:395 N SILVERBELL RD
Practice Address - Street 2:SUITE 355
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85745-2656
Practice Address - Country:US
Practice Address - Phone:520-622-5912
Practice Address - Fax:520-791-2246
Is Sole Proprietor?:No
Enumeration Date:2005-11-29
Last Update Date:2011-07-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ14913207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ239873Medicaid
D36655Medicare UPIN
AZ239873Medicaid