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General NPI Number Information
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NPI Number | 1720047152
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Entity Type | Individual
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Provider Name | ANTONIO GONZALEZ M.D
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Gender | Male
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Dates
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Enumeration Date | 03/23/2006
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Last Update Date | 03/21/2025
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Provider Practice Location Address
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Address Line | 125 BOSTON AVE
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City | IMMOKALEE
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State | FL
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Zip | 34142-4017
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Country | US
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Telephone | 239-658-3000
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Fax | 239-657-9600
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Provider Business Mailing Address
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Address Line | 1454 MADISON AVE W
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City | IMMOKALEE
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State | FL
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Zip | 34142-2200
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Country | US
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Telephone | 239-658-3000
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Fax |
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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 | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | ACN-248
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License Number State | FL
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