Healthcare Provider Details

I. General information

NPI: 1144490301
Provider Name (Legal Business Name): F. JORGE GONZALEZ, MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2008
Last Update Date: 03/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 CLAY AVE SUITE 299
ORLANDO FL
32804-4026
US

IV. Provider business mailing address

3100 CLAY AVE SUITE 299
ORLANDO FL
32804-4026
US

V. Phone/Fax

Practice location:
  • Phone: 407-447-1628
  • Fax:
Mailing address:
  • Phone: 407-447-1628
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. FLORENCIO JORGE GONZALEZ
Title or Position: PLASTIC SURGEON
Credential: M.D
Phone: 407-447-1628