MEDICARE: DR. JESUS 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
1	207Q00000X	Family Medicine Physician	ME 45503	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

General Provider Information

NPI Number	:	1881645729
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JESUS GONZALEZ JR. M.D.

Provider Business Mailing Address
First Line	:	PO BOX 190857
Second Line	:
City	:	MIAMI BEACH
State	:	FL
Zip	:	33119-0857
Country	:	US
Telephone Number	:	305-534-6251
Fax Number	:	305-667-5537

Provider Business Practice Location Address
First Line	:	1540 WASHINGTON AVE
Second Line	:
City	:	MIAMI BEACH
State	:	FL
Zip	:	33139-7801
Country	:	US
Telephone Number	:	305-534-6251
Fax Number	:	305-667-5537

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

Provider Enumeration Date	:	05/15/2006
Last Update Date	:	07/08/2007

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