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General NPI Number Information
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NPI Number | 1902163801
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Entity Type | Organization
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Legal Business Name | MIGUEL A GONZALEZ M.D. P.A
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Dates
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Enumeration Date | 04/16/2012
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Last Update Date | 04/16/2012
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Provider Practice Location Address
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Address Line | 401 SE 16TH ST
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City | FORT LAUDERDALE
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State | FL
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Zip | 33316-2529
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Country | US
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Telephone | 954-523-8108
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Fax | 954-525-9828
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Provider Business Mailing Address
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Address Line | 401 SE 16TH ST
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City | FORT LAUDERDALE
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State | FL
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Zip | 33316-2529
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Country | US
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Telephone | 954-523-8108
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Fax | 954-525-9828
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MIGUEL ANGEL GONZALEZ
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Credential | M.D.
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Telephone | 954-523-8108
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | 24288
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License Number State | FL
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