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Contact Information

SERGIO G GONZALEZ MD PA
119 SOUTH 12TH AVENUE
LAUREL, MS39440-4322
 Phone: 601-425-9763
 Fax: 601-428-5360
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Dermatopathology

207ZD0900X 22 Physician/Pathology
 

General Practice

208D00000X 99 Physician/Undefined Physician type[6]
Indicates primary specialty

NPI Profile & details for SERGIO G GONZALEZ MD PA

NPI Number 1952307308
LBN Legal business name SERGIO G GONZALEZ MD PA
Authorized official SERGIO GONZALEZ - (DIRECTOR)
Entity Organization
Organization subpart 1 No
Enumeration date 06/21/2005
Last updated 01/24/2008 - About 18 years ago
Identifiers
MS License # 06914
MS License # 6914
MS Medicaid 00013124
MS Other 512G70024 MEDICARE GROUP
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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