Provider Demographics
NPI:1083764245
Name:GONZALEZ, GERARDO A (MD)
Entity Type:Individual
Prefix:DR
First Name:GERARDO
Middle Name:A
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 352
Mailing Address - Street 2:
Mailing Address - City:ANASCO
Mailing Address - State:PR
Mailing Address - Zip Code:00610-0352
Mailing Address - Country:US
Mailing Address - Phone:787-826-8852
Mailing Address - Fax:
Practice Address - Street 1:6 VISTA MAR PLAZA
Practice Address - Street 2:BO. PUEBLO
Practice Address - City:RINCON
Practice Address - State:PR
Practice Address - Zip Code:00677
Practice Address - Country:US
Practice Address - Phone:787-823-0656
Practice Address - Fax:787-823-0656
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15048146D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146D00000XEmergency Medical Service ProvidersPersonal Emergency Response Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRI-022235Medicare ID - Type UnspecifiedMEDICARE