MEDICARE: DR. ANGEL E CHECA GONZALEZ MD

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	208D00000X	General Practice Physician	ACN1383	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	:	1881360303
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANGEL E CHECA GONZALEZ MD

Provider Business Mailing Address
First Line	:	12171 SW 268TH ST
Second Line	:
City	:	HOMESTEAD
State	:	FL
Zip	:	33032-8001
Country	:	US
Telephone Number	:	856-577-0869
Fax Number	:

Provider Business Practice Location Address
First Line	:	500 MCDUFF AVE S
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32254-4250
Country	:	US
Telephone Number	:	904-506-4044
Fax Number	:	904-490-8544

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

Provider Enumeration Date	:	08/17/2021
Last Update Date	:	01/13/2023

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