MEDICARE: DR. GONZALO 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	208VP0014X	Interventional Pain Medicine Physician	ME99529	FL
2	207R00000X	Internal Medicine Physician	ME99529	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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1477621373
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GONZALO GONZALEZ M.D.

Provider Business Mailing Address
First Line	:	2531 N DIXIE HWY
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33460-6250
Country	:	US
Telephone Number	:	561-582-0330
Fax Number	:

Provider Business Practice Location Address
First Line	:	2531 N DIXIE HWY
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33460-6250
Country	:	US
Telephone Number	:	561-582-0330
Fax Number	:	561-582-0339

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

Provider Enumeration Date	:	12/01/2006
Last Update Date	:	11/28/2023

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