Provider Demographics
NPI:1043315393
Name:GONZALEZ, REBECCA MCMULLEN (MD)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:MCMULLEN
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11821 REMSEN RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32223-0730
Mailing Address - Country:US
Mailing Address - Phone:904-657-1206
Mailing Address - Fax:
Practice Address - Street 1:11821 REMSEN RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32223-0730
Practice Address - Country:US
Practice Address - Phone:904-657-1206
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME957882083X0100X
KY356422083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLH70461Medicare UPIN