Healthcare Provider Details

I. General information

NPI: 1285641688
Provider Name (Legal Business Name): DOMINIC GONZALEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 12/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38135 MARKET SQUARE
ZEPHYRHILLS FL
33542
US

IV. Provider business mailing address

38135 MARKET SQUARE
ZEPHYRHILLS FL
33542
US

V. Phone/Fax

Practice location:
  • Phone: 813-780-1255
  • Fax: 813-780-9773
Mailing address:
  • Phone: 813-780-1255
  • Fax: 813-780-9773

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME55279
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: