MEDICARE: JUAN JOSE GONZALEZ M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RG0300X	Geriatric Medicine (Internal Medicine) Physician	15837	PR
2	261QV0200X	VA Clinic/Center	ME114422	FL

General Provider Information

NPI Number	:	1114070570
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUAN JOSE GONZALEZ M.D.

Provider Business Mailing Address
First Line	:	805 OAKLEY SEAVER DR
Second Line	:	SUITE A
City	:	CLERMONT
State	:	FL
Zip	:	34711-1968
Country	:	US
Telephone Number	:	321-235-0692
Fax Number	:	321-235-0694

Provider Business Practice Location Address
First Line	:	1834 N ALAFAYA TRL
Second Line	:	SUITE A
City	:	ORLANDO
State	:	FL
Zip	:	32826-4743
Country	:	US
Telephone Number	:	321-235-0692
Fax Number	:	321-235-0694

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/19/2007
Last Update Date	:	01/09/2017

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