Basic Information
| Provider Information | |||||||||
| NPI: | 1881311249 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GONZALES | ||||||||
| FirstName: | LOUISE STEFHANIE | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1135 NE 13TH ST APT 3 | ||||||||
| Address2: | |||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731171020 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8084299912 | ||||||||
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| Practice Location | |||||||||
| Address1: | 500 E ROBINSON ST STE 2300 | ||||||||
| Address2: | |||||||||
| City: | NORMAN | ||||||||
| State: | OK | ||||||||
| PostalCode: | 730716671 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4053294102 | ||||||||
| FaxNumber: | 4053075625 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/25/2022 | ||||||||
| LastUpdateDate: | 10/25/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/25/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208C00000X | 4872 | OK | Y | Allopathic & Osteopathic Physicians | Colon & Rectal Surgery |
No ID Information.