Provider Demographics
NPI:1083656128
Name:GONZALEZ, JULIO (MD)
Entity type:Individual
Prefix:
First Name:JULIO
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:241 NOKOMIS AVE S
Mailing Address - Street 2:SUITE B
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34285-2319
Mailing Address - Country:US
Mailing Address - Phone:941-485-3302
Mailing Address - Fax:941-485-2673
Practice Address - Street 1:241 NOKOMIS AVE S
Practice Address - Street 2:SUITE B
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34285-2319
Practice Address - Country:US
Practice Address - Phone:941-485-3302
Practice Address - Fax:941-485-2673
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2013-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME61283207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00121095OtherRAILROAD MEDICARE
FL271898700Medicaid
35812OtherBLUE CROSS BLUE SHIELD
FL5379810001OtherMEDICARE DME
FL35812WMedicare PIN
P00121095OtherRAILROAD MEDICARE