Healthcare Provider Details

I. General information

NPI: 1922177757
Provider Name (Legal Business Name): JORGE E GONZALEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1583 N MILITARY TRL STE A
WEST PALM BEACH FL
33409-4709
US

IV. Provider business mailing address

9186 OLMSTEAD DRIVE
LAKE WORTH FL
33467
US

V. Phone/Fax

Practice location:
  • Phone: 561-363-3151
  • Fax:
Mailing address:
  • Phone: 561-649-3268
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME0074971
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: