Provider Demographics
NPI:1053989970
Name:GONZALES, JOSHUA TYLER JOSEPH (DO)
Entity type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:TYLER JOSEPH
Last Name:GONZALES
Suffix:
Gender:M
Credentials:DO
Other - Prefix:DR
Other - First Name:JOSHUA
Other - Middle Name:
Other - Last Name:GONZALES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:DEPARTMENT OF GRADUATE MEDICAL EDUCATION
Mailing Address - Street 2:635 BARNHILL DRIVE
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202
Mailing Address - Country:US
Mailing Address - Phone:317-274-8282
Mailing Address - Fax:
Practice Address - Street 1:801 SAINT MARYS DR STE 510
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47714-0511
Practice Address - Country:US
Practice Address - Phone:812-485-4422
Practice Address - Fax:201-603-6684
Is Sole Proprietor?:No
Enumeration Date:2021-06-16
Last Update Date:2022-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IN11022533A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program