Healthcare Provider Details

I. General information

NPI: 1417180159
Provider Name (Legal Business Name): ALEJANDRO RAMON GONZALEZ BALLAGAS DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2009
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4879 COCONUT CREEK PKWY
COCONUT CREEK FL
33063-3944
US

IV. Provider business mailing address

14332 NW 87TH CT
MIAMI LAKES FL
33018-8044
US

V. Phone/Fax

Practice location:
  • Phone: 954-979-0505
  • Fax: 954-979-4298
Mailing address:
  • Phone: 786-630-0330
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number3777
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPO3777
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: