MEDICARE: DR. JOSE RAUL GONZALEZ-INCLAN 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	208600000X	Surgery Physician	5954	PR

General Provider Information

NPI Number	:	1891794434
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSE RAUL GONZALEZ-INCLAN M.D.

Provider Business Mailing Address
First Line	:	H6 CALLE BUCARE
Second Line	:
City	:	GUAYNABO
State	:	PR
Zip	:	00968-3116
Country	:	US
Telephone Number	:	787-751-4197
Fax Number	:	787-764-1828

Provider Business Practice Location Address
First Line	:	735 AVE PONCE DE LEON
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00917-5025
Country	:	US
Telephone Number	:	787-751-4197
Fax Number	:	787-764-1828

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

Provider Enumeration Date	:	07/16/2005
Last Update Date	:	07/08/2007

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