Provider Demographics
NPI:1093874380
Name:GONZALEZ-BLANCO, EDUARDO R (MD)
Entity Type:Individual
Prefix:
First Name:EDUARDO
Middle Name:R
Last Name:GONZALEZ-BLANCO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 12TH ST
Mailing Address - Street 2:SUITE 108
Mailing Address - City:KEY WEST
Mailing Address - State:FL
Mailing Address - Zip Code:33040-4088
Mailing Address - Country:US
Mailing Address - Phone:305-294-5576
Mailing Address - Fax:305-294-8182
Practice Address - Street 1:1111 12TH ST
Practice Address - Street 2:SUITE 108
Practice Address - City:KEY WEST
Practice Address - State:FL
Practice Address - Zip Code:33040-4088
Practice Address - Country:US
Practice Address - Phone:305-294-5576
Practice Address - Fax:305-294-8182
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME45502208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME45502OtherMEDICAL LICENSE
FLME45502OtherMEDICAL LICENSE