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General NPI Number Information
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NPI Number | 1568514073
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Entity Type | Organization
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Legal Business Name | JOSE M GONZALEZ-CANAL P A
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Dates
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Enumeration Date | 01/17/2007
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Last Update Date | 06/26/2008
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Provider Practice Location Address
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Address Line | 3390 TAMIAMI TRAIL, SUITE 104
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City | PORT CHARLOTTE
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State | FL
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Zip | 33952-8161
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Country | US
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Telephone | 941-764-0444
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Fax | 941-764-0774
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Provider Business Mailing Address
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Address Line | PO BOX 510276
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City | PUNTA GORDA
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State | FL
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Zip | 33951-0276
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Country | US
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Telephone | 941-764-0444
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Fax | 941-764-0774
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOSE M GONZALEZ-CANAL
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Credential | MD
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Telephone | 941-764-0444
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | ME0068859
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License Number State | FL
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