Healthcare Provider Details

I. General information

NPI: 1740844653
Provider Name (Legal Business Name): ARIEL GONZALEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/25/2019
Last Update Date: 09/13/2024
Certification Date: 09/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5964 US HIGHWAY 90
LIVE OAK FL
32060
US

IV. Provider business mailing address

1739 SW 67TH CIR
GAINESVILLE FL
32607
US

V. Phone/Fax

Practice location:
  • Phone: 386-963-6685
  • Fax: 386-963-6377
Mailing address:
  • Phone: 651-600-6198
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number023893
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberACN1652
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: