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NPI Code Detail

MEDICARE: JORGE A GONZALEZ DO

MEDICARE: JORGE A GONZALEZ DO
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
1207Q00000XFamily Medicine PhysicianOS4764FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1205922135
Entity Type Code : Individual
Provider Name (Legal Business Name) : JORGE A GONZALEZ DO
Provider Business Mailing Address
First Line : 4302 ALTON RD STE 1020
Second Line :
City : MIAMI BEACH
State : FL
Zip : 33140-2890
Country : US
Telephone Number : 305-672-9333
Fax Number : 305-672-9307
Provider Business Practice Location Address
First Line : 4302 ALTON RD STE 1020
Second Line :
City : MIAMI BEACH
State : FL
Zip : 33140-2890
Country : US
Telephone Number : 305-672-9333
Fax Number : 305-672-9307
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/05/2006
Last Update Date : 08/29/2024

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Directions to “ JORGE A GONZALEZ DO” Practice Location

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