Provider Demographics
NPI:1982637849
Name:GONZALEZ, OMAR Y (MD)
Entity type:Individual
Prefix:DR
First Name:OMAR
Middle Name:Y
Last Name:GONZALEZ
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 1:9060 E VIA LINDA STE 250
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-5425
Mailing Address - Country:US
Mailing Address - Phone:480-614-2000
Mailing Address - Fax:480-614-1751
Practice Address - Street 1:9060 E VIA LINDA STE 250
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-5425
Practice Address - Country:US
Practice Address - Phone:480-614-2000
Practice Address - Fax:480-614-1751
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ31845207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ862335-01Medicaid
AZZ80854Medicare PIN
AZ862335-01Medicaid