Provider Demographics
NPI:1598836082
Name:GONZALES, GENE G (MD)
Entity type:Individual
Prefix:DR
First Name:GENE
Middle Name:G
Last Name:GONZALES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3301 W. 144TH AVE.
Mailing Address - Street 2:STE. 200
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80023
Mailing Address - Country:US
Mailing Address - Phone:303-659-4248
Mailing Address - Fax:303-659-4283
Practice Address - Street 1:3301 W. 144TH AVE.
Practice Address - Street 2:STE. 200
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80023
Practice Address - Country:US
Practice Address - Phone:303-659-4248
Practice Address - Fax:303-659-4283
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2008-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO33544208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01335447Medicaid