Basic Information
| Provider Information | |||||||||
| NPI: | 1861522849 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GONZALEZ | ||||||||
| FirstName: | NESTOR | ||||||||
| MiddleName: | RUBEN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1698 OLD LEBANON RD | ||||||||
| Address2: | SUITE 3A | ||||||||
| City: | CAMPBELLSVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 427189662 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2704650632 | ||||||||
| FaxNumber: | 2707896119 | ||||||||
| Practice Location | |||||||||
| Address1: | 1698 OLD LEBANON RD | ||||||||
| Address2: | SUITE 3A | ||||||||
| City: | CAMPBELLSVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 427189662 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2704650632 | ||||||||
| FaxNumber: | 2707896119 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/07/2007 | ||||||||
| LastUpdateDate: | 11/23/2010 | ||||||||
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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 | 390200000X | 11011414A | IN | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 390200000X | FT335 | KY | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207XX0005X | 43819 | KY | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Sports Medicine |
No ID Information.