Healthcare Provider Details

I. General information

NPI: 1215957766
Provider Name (Legal Business Name): JOSE A GONZALEZ MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 09/24/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10001 TORCHWOOD AVE
PLANTATION FL
33324-2217
US

IV. Provider business mailing address

10001 TORCHWOOD AVE
PLANTATION FL
33324-2217
US

V. Phone/Fax

Practice location:
  • Phone: 305-551-3200
  • Fax: 305-255-1669
Mailing address:
  • Phone: 305-551-3200
  • Fax: 305-255-1669

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberME86707
License Number StateFL

VIII. Authorized Official

Name: JOSE A GONZALEZ
Title or Position: MD
Credential: MD PA
Phone: 305-551-3200