MEDICARE: MR. EDWIN GONZALEZ-NAVEDO MD

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	208600000X	Surgery Physician	ME92298	FL

Other Identifiers

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

General Provider Information

NPI Number	:	1710971460
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. EDWIN GONZALEZ-NAVEDO MD

Provider Business Mailing Address
First Line	:	3140 NW MEDICAL CENTER LN
Second Line	:	SUITE 120
City	:	LAKE CITY
State	:	FL
Zip	:	32055-4717
Country	:	US
Telephone Number	:	386-755-6682
Fax Number	:	386-755-6796

Provider Business Practice Location Address
First Line	:	3140 NW MEDICAL CENTER LN
Second Line	:	SUITE 120
City	:	LAKE CITY
State	:	FL
Zip	:	32055-4717
Country	:	US
Telephone Number	:	386-755-6682
Fax Number	:	386-755-6796

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

Provider Enumeration Date	:	09/08/2005
Last Update Date	:	10/03/2007

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