Sergio G Gonzalez MD PA

Primary specialty

Dermatopathology (Pathology) PhysicianTaxonomy code 207ZD0900X

License

6914 Issued in MS

Legal business name

SERGIO G GONZALEZ MD PA

Practice address

119 South 12TH Avenue
Laurel, MS 39440-4322

Phone

(601) 425-9763

Fax

(601) 428-5360

NPI assigned

Jun 21, 2005

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Sergio G Gonzalez, MD

Title

Director

Phone

(601) 649-5842

Specialties & licenses 2

Addresses

Other identifiers 2

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1119312000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1201132800000",
    "number": "1952307308",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "119 SOUTH 12TH AVENUE",
            "city": "LAUREL",
            "state": "MS",
            "postal_code": "394404322",
            "telephone_number": "601-425-9763",
            "fax_number": "601-428-5360"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "119 SOUTH 12TH AVENUE",
            "city": "LAUREL",
            "state": "MS",
            "postal_code": "394404322",
            "telephone_number": "601-425-9763",
            "fax_number": "601-428-5360"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SERGIO G GONZALEZ MD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-21",
        "last_updated": "2008-01-24",
        "status": "A",
        "authorized_official_last_name": "GONZALEZ",
        "authorized_official_first_name": "SERGIO",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "601-649-5842",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207ZD0900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pathology, Dermatopathology",
            "state": "MS",
            "license": "6914",
            "primary": true
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": "MS",
            "license": "06914",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP",
            "identifier": "512G70024",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00013124",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Carmel Savell, PCIDDT
• Grant Patrick Saxton, M.D.
• Rebecca Suzanne Scarbrough, CNP
• Victoria Paige Scruggs, M.S., CCC-SLP
• Anna Seals, FNP-C
• Ihtesham Shafiq, MD
• Sandra Sharplin, RN
• Kristin B Shehan, LPN
• William Blake Sherman, DPT
• Kelsa Shirley, FNP

• Dermatopathology (Pathology) Physician in Laurel, MS
• Providers in Laurel, MS by specialty
• Dermatopathology (Pathology) Physician in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.