Doctor Name: | DR. EDGAR GONZALEZ |
NPI Number: | 1801132121 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.D |
License Number: | 014723I |
Business Practice Address: | 16625 Sw 296th St Homestead, FL - 330332127 |
Business Phone Number: | 7867183739 |
Business Fax Number: | |
Mailing Address: | 16625 Sw 296th St, HOMESTEAD |
State: | FL |
Postal Code: | 330332127 |
Phone Number: | 7867183739 |
Fax Number: | |
NPI Enumeration Date: | 12/13/2012 |
NPI Last Update Date: | 12/13/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | 014723I |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | PR |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |