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General NPI Number Information
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NPI Number | 1841481512
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Entity Type | Organization
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Legal Business Name | ALEX L GONZALES MD PA
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Dates
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Enumeration Date | 08/07/2007
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Last Update Date | 08/25/2014
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Provider Practice Location Address
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Address Line | 4251 NW AMERICAN LANE STE 101
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City | LAKE CITY
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State | FL
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Zip | 32055-4881
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Country | US
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Telephone | 386-758-6143
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Fax | 386-758-6046
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Provider Business Mailing Address
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Address Line | 4251 NW AMERICAN LANE STE 101
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City | LAKE CITY
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State | FL
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Zip | 32055-4881
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Country | US
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Telephone | 386-758-6143
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Fax | 386-758-6046
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Authorized Official
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Title or Position | PHYSICIAN AND OWNER OF PRACTICE
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Name | DR. ALEX L GONZALES
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Credential | MD PA
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Telephone | 386-758-6143
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | ME61910
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License Number State | FL
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