Healthcare Provider Details

I. General information

NPI: 1376536235
Provider Name (Legal Business Name): ROBERTO GONZALEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: ROBERTO GONZALEZ COLON M.D.

II. Dates (important events)

Enumeration Date: 08/25/2005
Last Update Date: 07/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 CYPRESS PKWY
KISSIMMEE FL
34759-3328
US

IV. Provider business mailing address

PO BOX 616788
ORLANDO FL
32861-6788
US

V. Phone/Fax

Practice location:
  • Phone: 407-483-1400
  • Fax: 407-483-1405
Mailing address:
  • Phone: 407-253-3535
  • Fax: 407-770-0661

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME115410
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: