Provider Demographics
NPI:1487957858
Name:ALFREDO E GONZALEZ MD PA
Entity type:Organization
Organization Name:ALFREDO E GONZALEZ MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALFREDO
Authorized Official - Middle Name:E
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-645-2737
Mailing Address - Street 1:201 N LAKEMONT AVE STE 800
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-3228
Mailing Address - Country:US
Mailing Address - Phone:407-645-2737
Mailing Address - Fax:407-645-1082
Practice Address - Street 1:201 N LAKEMONT AVE STE 800
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-3228
Practice Address - Country:US
Practice Address - Phone:407-645-2737
Practice Address - Fax:407-645-1082
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-07
Last Update Date:2013-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME67354207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE47976Medicare UPIN
FL26401Medicare PIN