=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598866683
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ROBERT T GONZALEZ, MD,FAAP,PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/25/2006
-----------------------------------------------------
Last Update Date | 03/27/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2301 N UNIVERSITY DR SUITE 202
-----------------------------------------------------
City | PEMBROKE PINES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33024-3617
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-433-1825
-----------------------------------------------------
Fax | 954-433-1827
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2301 N UNIVERSITY DR SUITE 202
-----------------------------------------------------
City | PEMBROKE PINES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33024-3617
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-433-1825
-----------------------------------------------------
Fax | 954-433-1827
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | MRS. MAYRA GONZALEZ
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 954-433-1825
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | ME53651
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------