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General NPI Number Information
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NPI Number | 1407409386
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Entity Type | Individual
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Provider Name | ALEXIS ROBERTO GONZALEZ VALLES MD
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Gender | Male
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Dates
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Enumeration Date | 07/19/2019
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Last Update Date | 07/28/2025
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Provider Practice Location Address
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Address Line | 1931 S NARCOOSSEE RD
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City | SAINT CLOUD
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State | FL
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Zip | 34771-7211
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Country | US
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Telephone | 407-986-9642
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Fax | 407-593-6102
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Provider Business Mailing Address
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Address Line | 425 W COLONIAL DR STE 303
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City | ORLANDO
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State | FL
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Zip | 32804-6863
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Country | US
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Telephone | 321-332-6947
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Fax | 407-286-4515
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | ACN1234
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 21503
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License Number State | PR
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Taxonomy #3
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | ACN1234
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License Number State | FL
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