Basic Information
| Provider Information | |||||||||
| NPI: | 1821096363 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GONZALEZ | ||||||||
| FirstName: | RENE | ||||||||
| MiddleName: | MIGUEL | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2775 SCHOENERSVILLE RD | ||||||||
| Address2: | |||||||||
| City: | BETHLEHEM | ||||||||
| State: | PA | ||||||||
| PostalCode: | 180177307 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6108618080 | ||||||||
| FaxNumber: | 6108070366 | ||||||||
| Practice Location | |||||||||
| Address1: | 2775 SCHOENERSVILLE RD | ||||||||
| Address2: | |||||||||
| City: | BETHLEHEM | ||||||||
| State: | PA | ||||||||
| PostalCode: | 180177307 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6108618080 | ||||||||
| FaxNumber: | 6108070366 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/08/2005 | ||||||||
| LastUpdateDate: | 05/09/2008 | ||||||||
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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 | 207L00000X | MD032860E | PA | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 50048291 | 01 | KEYSTONE HEALTH PLAN CENTRAL | OTHER | 9911829 | 01 | CIGNA HEALTHCARE | OTHER | 0013113000 | 01 | AMERIHEALTH | OTHER | 033430 | 01 | HIGHMARK BLUE SHIELD | OTHER | 50048291 | 01 | CAPITAL BLUE CROSS | OTHER | 56208 | 01 | GEISINGER HEALTH PLAN | OTHER | 0013113000 | 01 | INDEPENDENCE BLUE CROSS | OTHER | 2170519 | 01 | MAMSI | OTHER | P3394608 | 01 | OXFORD HEALTH PLANS | OTHER | 9352078 | 01 | PRIVATE HEALTHCARE SYSTEMS | OTHER | 0013113000 | 01 | KEYSTONE HEALTH PLAN EAST | OTHER | P00234897 | 01 | MEDICARE RAILROAD | OTHER |