MEDICARE: IGNACIO GONZALEZ-GOMEZ 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	207ZP0213X	Pediatric Pathology Physician	ME104028	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1981246	OTHER	FL	CIGNA
2	1454H	OTHER	FL	BLUE CROSS/BLUE SHIELD
3	294635	OTHER	FL	STAYWELL/HEALTHEASE
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	331553	OTHER	FL	AVMED
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	7913502	OTHER	FL	AETNA
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1720187610
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IGNACIO GONZALEZ-GOMEZ M.D.

Provider Business Mailing Address
First Line	:	501 6TH AVE S
Second Line	:	BOX 6941
City	:	ST PETERSBURG
State	:	FL
Zip	:	33701-4634
Country	:	US
Telephone Number	:	727-767-4429
Fax Number	:	727-767-4970

Provider Business Practice Location Address
First Line	:	501 6TH AVE S
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33701-4634
Country	:	US
Telephone Number	:	727-767-4341
Fax Number	:	727-767-8516

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

Provider Enumeration Date	:	09/21/2006
Last Update Date	:	03/03/2010

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