Provider Demographics
NPI:1588762082
Name:GONZALEZ, JULIO C (MD)
Entity type:Individual
Prefix:
First Name:JULIO
Middle Name:C
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:PO BOX 720533
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33172-0009
Mailing Address - Country:US
Mailing Address - Phone:305-643-9292
Mailing Address - Fax:305-643-9266
Practice Address - Street 1:4550 NW 7TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-2307
Practice Address - Country:US
Practice Address - Phone:305-643-9292
Practice Address - Fax:305-643-9266
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0065735207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL374656900Medicaid
F76329Medicare UPIN
FL374656900Medicaid