Healthcare Provider Details

I. General information

NPI: 1285638171
Provider Name (Legal Business Name): GONZALO J LOVEDAY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2005
Last Update Date: 08/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 UNIVERSITY BLVD 200
JUPITER FL
33458-2778
US

IV. Provider business mailing address

600 UNIVERSITY BLVD 200
JUPITER FL
33458-2778
US

V. Phone/Fax

Practice location:
  • Phone: 561-627-2210
  • Fax: 561-627-2130
Mailing address:
  • Phone: 561-627-2210
  • Fax: 561-627-2130

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberME98727
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: