Healthcare Provider Details

I. General information

NPI: 1306978572
Provider Name (Legal Business Name): JEFFREY E GONZALEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AK12 CALLE 8 PRADERA
TOA BAJA PR
00949-4081
US

IV. Provider business mailing address

AK12 CALLE 8 PRADERA
TOA BAJA PR
00949-4081
US

V. Phone/Fax

Practice location:
  • Phone: 787-774-3344
  • Fax: 787-774-6251
Mailing address:
  • Phone: 787-774-3344
  • Fax: 787-774-6251

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number14216
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: