Provider Demographics
NPI:1184640864
Name:GONZALEZ-PANTALEON, JOSE ADALBERTO (MD)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:ADALBERTO
Last Name:GONZALEZ-PANTALEON
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 1:10001 TORCHWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-2217
Mailing Address - Country:US
Mailing Address - Phone:305-670-4424
Mailing Address - Fax:305-255-1669
Practice Address - Street 1:10001 TORCHWOOD AVE
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-2217
Practice Address - Country:US
Practice Address - Phone:305-670-4424
Practice Address - Fax:305-255-1669
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2007-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 0086707207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL266618900Medicaid
FL266618900Medicaid
H80305Medicare UPIN