Provider Demographics
NPI:1992770663
Name:GONZALEZ-PUJOL, ENRIQUE AGUSTIN (MD)
Entity type:Individual
Prefix:
First Name:ENRIQUE
Middle Name:AGUSTIN
Last Name:GONZALEZ-PUJOL
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 1:5941 NW 173RD DR
Mailing Address - Street 2:6
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33015-5109
Mailing Address - Country:US
Mailing Address - Phone:305-705-3014
Mailing Address - Fax:305-873-6173
Practice Address - Street 1:5941 NW 173RD DR
Practice Address - Street 2:6
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33015-5109
Practice Address - Country:US
Practice Address - Phone:305-705-3014
Practice Address - Fax:305-873-6173
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2010-12-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FL207Q00000X207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL042158800Medicaid
FL96298Medicare ID - Type Unspecified
FL042158800Medicaid