MEDICARE: DR. GABRIEL ANTONIO GONZALES-PORTILLO 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	207T00000X	Neurological Surgery Physician	ME93271	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	:	1811992357
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GABRIEL ANTONIO GONZALES-PORTILLO M.D.

Provider Business Mailing Address
First Line	:	6919 N DALE MABRY HWY STE 100
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33614-3972
Country	:	US
Telephone Number	:	813-467-4290
Fax Number	:

Provider Business Practice Location Address
First Line	:	6919 N DALE MABRY HWY STE 100
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33614-3972
Country	:	US
Telephone Number	:	813-467-4290
Fax Number	:

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

Provider Enumeration Date	:	06/20/2005
Last Update Date	:	07/28/2023

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