| Sergio G Gonzalez Md Pa | |
|
119 South 12th Avenue Laurel MS 39440-4322 | |
| (601) 425-9763 | |
| (601) 428-5360 |
| Full Name | Sergio G Gonzalez Md Pa |
|---|---|
| Speciality | Pathology - Dermatopathology |
| Location | 119 South 12th Avenue, Laurel, Mississippi |
| Authorized Official Name and Position | Sergio G Gonzalez (DIRECTOR) |
| Authorized Official Contact | 6016495842 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Sergio G Gonzalez Md Pa 119 South 12th Avenue Laurel MS 39440-4322 Ph: (601) 425-9763 | Sergio G Gonzalez Md Pa 119 South 12th Avenue Laurel MS 39440-4322 Ph: (601) 425-9763 |
| NPI Number | 1952307308 |
|---|---|
| Provider Enumeration Date | 06/21/2005 |
| Last Update Date | 01/24/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1952307308 | NPI | - | NPPES |
| 512G70024 | Other | MS | MEDICARE GROUP |
| 00013124 | Medicaid | MS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | 06914 (Mississippi) | Secondary |
| 207ZD0900X | Pathology - Dermatopathology | 6914 (Mississippi) | Primary |
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