MEDICARE: DR. GEORGE 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	2084N0400X	Neurology Physician	231414	MA

General Provider Information

NPI Number	:	1619029287
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GEORGE GONZALEZ M.D.

Provider Business Mailing Address
First Line	:	1111 KANE CONCOURSE STE 504
Second Line	:
City	:	BAY HARBOR ISLANDS
State	:	FL
Zip	:	33154-2043
Country	:	US
Telephone Number	:	305-865-1995
Fax Number	:	305-866-2920

Provider Business Practice Location Address
First Line	:	1111 KANE CONCOURSE STE 504
Second Line	:
City	:	BAY HARBOR ISLANDS
State	:	FL
Zip	:	33154-2043
Country	:	US
Telephone Number	:	305-865-1995
Fax Number	:	305-866-2920

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

Provider Enumeration Date	:	01/17/2007
Last Update Date	:	05/10/2022

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