Provider Demographics
NPI:1124113899
Name:GORDO GONZALEZ, VICTOR M SR (MD)
Entity type:Individual
Prefix:
First Name:VICTOR
Middle Name:M
Last Name:GORDO GONZALEZ
Suffix:SR
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:COND SAN FRANCISCO JAVIER NUM 406
Mailing Address - Street 2:CALLE SAN JOSE NUM 50
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969
Mailing Address - Country:US
Mailing Address - Phone:787-756-8186
Mailing Address - Fax:787-281-0036
Practice Address - Street 1:AVE PONCE DE LEON # 708
Practice Address - Street 2:SUITE 204
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-1000
Practice Address - Country:US
Practice Address - Phone:787-756-8186
Practice Address - Fax:787-281-0036
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2010-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9049207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E43490Medicare UPIN
PR81769Medicare ID - Type Unspecified