Healthcare Provider Details

I. General information

NPI: 1720187610
Provider Name (Legal Business Name): IGNACIO GONZALEZ-GOMEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 03/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 6TH AVE S
ST PETERSBURG FL
33701-4634
US

IV. Provider business mailing address

501 6TH AVE S BOX 6941
ST PETERSBURG FL
33701-4634
US

V. Phone/Fax

Practice location:
  • Phone: 727-767-4341
  • Fax: 727-767-8516
Mailing address:
  • Phone: 727-767-4429
  • Fax: 727-767-4970

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0213X
TaxonomyPediatric Pathology Physician
License NumberME104028
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: