Provider Demographics
NPI:1134114978
Name:GONZALEZ, JAVIER R (DO)
Entity Type:Individual
Prefix:
First Name:JAVIER
Middle Name:R
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 WOODMONT BLVD STE 600
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37205-5250
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9852-54 LITTLE ROAD
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34654
Practice Address - Country:US
Practice Address - Phone:727-425-6902
Practice Address - Fax:727-425-6904
Is Sole Proprietor?:No
Enumeration Date:2005-09-19
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS8255207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL272435900Medicaid
FL37365OtherBCBS OF FL
I12072Medicare UPIN
FL272435900Medicaid