MEDICARE: DR. E GONZALEZ MD PA

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	207Q00000X	Family Medicine Physician	ME25089	FL

Other Identifiers

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

General Provider Information

NPI Number	:	1306864913
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. E GONZALEZ MD PA

Provider Business Mailing Address
First Line	:	4755 SUMMERLIN RD
Second Line	:	SUITE 8
City	:	FORT MYERS
State	:	FL
Zip	:	33919-1073
Country	:	US
Telephone Number	:	239-275-5339
Fax Number	:	239-275-5592

Provider Business Practice Location Address
First Line	:	4755 SUMMERLIN RD
Second Line	:	SUITE 8
City	:	FORT MYERS
State	:	FL
Zip	:	33919-1073
Country	:	US
Telephone Number	:	239-275-5339
Fax Number	:	239-275-5592

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

Provider Enumeration Date	:	07/18/2006
Last Update Date	:	02/08/2026

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