Healthcare Provider Details

I. General information

NPI: 1326205774
Provider Name (Legal Business Name): ROBERTO RENE GONZALEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2008
Last Update Date: 10/21/2020
Certification Date: 10/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7500 SW 87TH AVE STE 200
MIAMI FL
33173-5426
US

IV. Provider business mailing address

7500 SW 87TH AVE STE 200
MIAMI FL
33173-5426
US

V. Phone/Fax

Practice location:
  • Phone: 305-913-0666
  • Fax: 305-913-0663
Mailing address:
  • Phone: 305-913-0666
  • Fax: 305-913-0666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberME119134
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: