MEDICARE: ALEX L GONZALES 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	207R00000X	Internal Medicine Physician	ME61910	FL

General Provider Information

NPI Number	:	1841481512
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALEX L GONZALES MD PA

Provider Business Mailing Address
First Line	:	4251 NW AMERICAN LANE
Second Line	:	STE 101
City	:	LAKE CITY
State	:	FL
Zip	:	32055-4881
Country	:	US
Telephone Number	:	386-758-6143
Fax Number	:	386-758-6046

Provider Business Practice Location Address
First Line	:	4251 NW AMERICAN LANE
Second Line	:	STE 101
City	:	LAKE CITY
State	:	FL
Zip	:	32055-4881
Country	:	US
Telephone Number	:	386-758-6143
Fax Number	:	386-758-6046

Authorized Official
Title or Position	:	PHYSICIAN AND OWNER OF PRACTICE
Name	:	DR. ALEX L GONZALES
Credential	:	MD PA
Telephone Number	:	386-758-6143

Provider Enumeration Date	:	08/07/2007
Last Update Date	:	08/25/2014

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