Healthcare Provider Details

I. General information

NPI: 1518957166
Provider Name (Legal Business Name): PAUL J GONZALEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2005
Last Update Date: 03/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3531 LITTLE RD
TRINITY FL
34655-1811
US

IV. Provider business mailing address

PO BOX 1527
ELFERS FL
34680-1527
US

V. Phone/Fax

Practice location:
  • Phone: 727-842-9900
  • Fax: 727-844-5425
Mailing address:
  • Phone: 727-842-9900
  • Fax: 727-844-5425

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberME67843
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: