Provider Demographics
NPI:1588683585
Name:GONZALEZ, GEORGE DANIEL (MD)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:DANIEL
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:444 CLINCHFIELD STREET
Mailing Address - Street 2:SUITE 2900
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660
Mailing Address - Country:US
Mailing Address - Phone:423-245-6101
Mailing Address - Fax:423-245-2396
Practice Address - Street 1:444 CLINCHFIELD STREET
Practice Address - Street 2:SUITE 2900
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660
Practice Address - Country:US
Practice Address - Phone:423-245-6101
Practice Address - Fax:423-245-2396
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2015-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD199622085R0204X, 208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA265295OtherANTHEM BCBS VIRGINIA
TN20043969OtherRAILROAD MEDICARE
TN3046049Medicaid
4656188OtherAETNA
TN3130863OtherBCBS TENNESSEE
VA7311095OtherVIRGINIA MEDICAID
TN20043969OtherRAILROAD MEDICARE
VA265295OtherANTHEM BCBS VIRGINIA