Provider Demographics
NPI:1215957766
Name:JOSE A GONZALEZ MD PA
Entity type:Organization
Organization Name:JOSE A GONZALEZ MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:A
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD PA
Authorized Official - Phone:305-551-3200
Mailing Address - Street 1:10001 TORCHWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-2217
Mailing Address - Country:US
Mailing Address - Phone:305-551-3200
Mailing Address - Fax:305-255-1669
Practice Address - Street 1:10001 TORCHWOOD AVE
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-2217
Practice Address - Country:US
Practice Address - Phone:305-551-3200
Practice Address - Fax:305-255-1669
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2007-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME86707174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLH80305Medicare UPIN
FLK5417Medicare PIN