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General NPI Number Information
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NPI Number | 1912217936
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Entity Type | Individual
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Provider Name | EDWARD GONZALEZ D.P.M,
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Gender | Male
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Dates
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Enumeration Date | 10/08/2010
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Last Update Date | 10/03/2016
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Provider Practice Location Address
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Address Line | 330 SW 27TH AVE SUITE 403
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City | MIAMI
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State | FL
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Zip | 33135-2961
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Country | US
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Telephone | 305-517-3771
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 430764
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City | SOUTH MIAMI
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State | FL
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Zip | 33243-0764
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Country | US
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Telephone | 305-301-0005
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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 | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | PO3451
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License Number State | FL
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