Provider Demographics
NPI:1528122199
Name:GONZALES, TARA LITTLEJOHN (MD)
Entity type:Individual
Prefix:DR
First Name:TARA
Middle Name:LITTLEJOHN
Last Name:GONZALES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:4220 N DAVIS HWY
Mailing Address - Street 2:BLDG A STE 200
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-2752
Mailing Address - Country:US
Mailing Address - Phone:850-477-5475
Mailing Address - Fax:850-477-8186
Practice Address - Street 1:4220 N DAVIS HWY
Practice Address - Street 2:BLDG A STE 200
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-2752
Practice Address - Country:US
Practice Address - Phone:850-477-5475
Practice Address - Fax:850-477-8186
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME74861208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics