Basic Information
| Provider Information | |||||||||
| NPI: | 1669635785 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GONZALES | ||||||||
| FirstName: | MICHAEL RAYMUND | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 850 HARVARD WAY | ||||||||
| Address2: | |||||||||
| City: | RENO | ||||||||
| State: | NV | ||||||||
| PostalCode: | 895022055 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5182530772 | ||||||||
| FaxNumber: | 7759825496 | ||||||||
| Practice Location | |||||||||
| Address1: | 10085 DOUBLE R BLVD STE 310 | ||||||||
| Address2: | |||||||||
| City: | RENO | ||||||||
| State: | NV | ||||||||
| PostalCode: | 895214832 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7759827260 | ||||||||
| FaxNumber: | 7759827268 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/09/2008 | ||||||||
| LastUpdateDate: | 07/23/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RE0101X | 21747 | MS | N | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism | 207RE0101X | 309848 | LA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism | 390200000X | 0116019889 | VA | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207RE0101X | 16309 | NV | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism |
ID Information
| ID | Type | State | Issuer | Description | 13817541 | 01 | NV | CAQH NUMBER | OTHER | 6056931 | 01 | MS | HEALTHSPRINGS | OTHER | 931868 | 01 | MS | WINDSOR HEALTH PLAN | OTHER | 9971837 | 01 | MS | AETNA | OTHER | P01109797 | 01 | MS | RAILROAD MEDICARE | OTHER | 16309 | 01 | NV | NV MD LIC NUMBER | OTHER | 3447931 | 01 | MS | UNITED HEALTHCARE | OTHER | 8822998 | 01 | MS | CIGNA | OTHER | 1669635785 | 05 | NV | MEDICAID | 09338860 | 05 | MS | MEDICAID |