SERGIO G GONZALEZ MD PA (NPI# 1952307308) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1952307308 |
| Entity Type | Organization |
| Organization Name | SERGIO G GONZALEZ MD PA |
| Practice Address |
119 South 12th Avenue Laurel MS 39440-4322 |
| Practice Telephone | 6014259763 |
| Practice Fax Number | 6014285360 |
| Mailing Telephone | 6014259763 |
| Mailing Fax Number | 6014285360 |
| Enumeration Date | 2005-06-21 |
| Last Update Date | 2008-01-24 |
| Authorized Official Name | DR. SERGIO G GONZALEZ (DIRECTOR) |
| Authorized Official Telephone | 6016495842 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 208D00000X | General Practice | 06914 | MS | Allopathic & Osteopathic Physicians |
| Y | 207ZD0900X |
Pathology Specialization: Dermatopathology |
6914 | MS | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MS | 00013124 | 05 | |
| MS | MEDICARE GROUP | 512G70024 | 01 |
| Street Address |
119 SOUTH 12TH AVENUE |
| City | LAUREL |
| State | MS |
| Zip Code | 39440-4322 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306323159 | Tender Loving Care Homecare LLC | Homemaker | 509 Central Ave Ste 224, Laurel, MS 39440 | 2018-07-24 |
| 1669837910 | Laurel Dental Properties | Dentist | 1925 Pine Belt Drive, Laurel, MS 39440 | 2015-12-30 |
| 1215282991 | South Central Regional Medical Center | Clinic/Center | 525 Wayne Drive, Laurel, MS 39440 | 2012-07-18 |
| 1568721215 | Terry Ratcliff Perkins | Counselor | 5192 Hwy 11 North, Laurel, MS 39440 | 2012-05-15 |
| 1437453057 | Alexander Milne Home for Women | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 616 East 19th Street, Laurel, MS 39440 | 2010-12-23 |
| 1710135629 | Jeffrey R. Moffett | Nurse Practitioner | 3115 Audubon Dr, Laurel, MS 39440 | 2008-09-04 |
| 1003096785 | Family Health Center, Inc | Obstetrics & Gynecology | 103 S. 12th Avenue, Laurel, MS 39440 | 2007-11-09 |
| 1669672143 | Laurel Urology Clinic Pa | Urology | 304 S 10th Ave, Laurel, MS 39440 | 2007-07-23 |
| 1093912370 | Tanweer Hussain Majid | Surgery | 1007 Jefferson Street, Laurel, MS 39440 | 2007-06-29 |
| 1780889923 | Hattiesburg Eye Clinic, Pa | Ophthalmology | 1431 North 10th St, Suite 1, Laurel, MS 39440 | 2007-06-18 |
| Find all providers in zip 39440 | ||||
| Taxonomy Code | 207ZD0900X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pathology |
| Specialization | Dermatopathology |
| A dermatopathologist is an expert in diagnosing and monitoring diseases of the skin including infectious, immunologic, degenerative, and neoplastic diseases. This entails the examination and interpretation of specially prepared tissue sections, cellular scrapings, and smears of skin lesions by means of light microscopy, electron microscopy, and fluorescence microscopy. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton changed, source added] Additional Resources: American Board of Pathology, 2007. http://www.abpath.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Pathology. A subspecialty certificate was first issued by the ABMS in 1974. ACGME Accredited Residency Program Requirements: None. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366443210 | Sergio G Gonzalez | Pathology | 119 S 12th Ave, Laurel, MS 39440-4322 | 2005-08-02 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740572676 | Buu Duong | Pathology | 3120 Old Canton Rd, Jackson, MS 39216-4219 | 2011-05-11 |
| 1033432653 | Jennifer S Schulmeier | Pathology | 3120 Old Canton Rd, Jackson, MS 39216-4219 | 2010-03-10 |
| 1063735686 | Billy L Walker | Pathology | 3120 Old Canton Rd, Jackson, MS 39216-4219 | 2010-03-10 |
| 1770672768 | Hattiesburg Clinic Pa | Pathology | 421 S 28th Ave, Suite 310, Hattiesburg, MS 39401-7206 | 2006-10-11 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.