Provider Demographics
NPI:1306978572
Name:GONZALEZ, JEFFREY E (MD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:E
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:AK12 CALLE 8
Mailing Address - Street 2:PRADERA
Mailing Address - City:TOA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00949-4081
Mailing Address - Country:US
Mailing Address - Phone:787-774-3344
Mailing Address - Fax:787-774-6251
Practice Address - Street 1:AK12 CALLE 8
Practice Address - Street 2:PRADERA
Practice Address - City:TOA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00949-4081
Practice Address - Country:US
Practice Address - Phone:787-774-3344
Practice Address - Fax:787-774-6251
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR142162083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine