MEDICARE: ROBERTO RAUL GONZALEZ M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	47075	TN
2	390200000X	Student in an Organized Health Care Education/Training Program	BP10028868	TX
3	207Q00000X	Family Medicine Physician	ME114294	FL

General Provider Information

NPI Number	:	1316197668
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERTO RAUL GONZALEZ M.D.

Provider Business Mailing Address
First Line	:	3850 W. FLAGLER ST.
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33134-1604
Country	:	US
Telephone Number	:	305-774-3400
Fax Number	:	305-442-0482

Provider Business Practice Location Address
First Line	:	3850 W. FLAGLER ST.
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33134-1604
Country	:	US
Telephone Number	:	305-774-3400
Fax Number	:	305-442-0482

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/23/2008
Last Update Date	:	04/05/2013

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