Healthcare Provider Details

I. General information

NPI: 1902806151
Provider Name (Legal Business Name): MELCHOR GONZALEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2005
Last Update Date: 10/21/2025
Certification Date: 10/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

61 MEMORIAL MEDICAL PKWY SUITE 3816
PALM COAST FL
32164-5981
US

IV. Provider business mailing address

61 MEMORIAL MEDICAL PKWY SUITE 3816
PALM COAST FL
32164-5981
US

V. Phone/Fax

Practice location:
  • Phone: 386-586-1720
  • Fax: 386-586-5422
Mailing address:
  • Phone: 386-586-1720
  • Fax: 386-586-5422

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberMD-23968
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberMED-PHYS-LIC-111885
License Number StateMT
# 3
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberME72928
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: