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NPI Code Detail

MEDICARE: DR. JORGE ANTONIO GONZALEZ JR. M.D.

MEDICARE: DR. JORGE ANTONIO GONZALEZ JR. 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
1207RS0010XSports Medicine (Internal Medicine) PhysicianME128315FL
2207R00000XInternal Medicine PhysicianME128315FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1427390137
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JORGE ANTONIO GONZALEZ JR. M.D.
Provider Business Mailing Address
First Line : 3333 W COMMERCIAL BLVD STE 101
Second Line :
City : FORT LAUDERDALE
State : FL
Zip : 33309-3424
Country : US
Telephone Number : 954-751-6990
Fax Number : 954-751-6991
Provider Business Practice Location Address
First Line : 3333 W COMMERCIAL BLVD STE 101
Second Line :
City : FORT LAUDERDALE
State : FL
Zip : 33309-3424
Country : US
Telephone Number : 954-751-6990
Fax Number : 954-751-6991
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/20/2013
Last Update Date : 03/17/2022

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Directions to “ DR. JORGE ANTONIO GONZALEZ JR. M.D.” Practice Location

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