Healthcare Provider Details

I. General information

NPI: 1083920367
Provider Name (Legal Business Name): EITTEL OPPENHEIMER GONZALEZ MD, FACS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2010
Last Update Date: 10/19/2023
Certification Date: 10/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER RD BOX 100286
GAINESVILLE FL
32610-0286
US

IV. Provider business mailing address

1600 SW ARCHER RD BOX 100286
GAINESVILLE FL
32610-0286
US

V. Phone/Fax

Practice location:
  • Phone: 352-265-0761
  • Fax:
Mailing address:
  • Phone: 352-265-0761
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number12722-I
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberME124884
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: