Provider Demographics
NPI:1225026297
Name:GONZALEZ, PEDRO A (MD)
Entity Type:Individual
Prefix:DR
First Name:PEDRO
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 1601
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00681-1601
Mailing Address - Country:US
Mailing Address - Phone:787-832-3037
Mailing Address - Fax:787-265-1895
Practice Address - Street 1:55 CALLE MEDITACION
Practice Address - Street 2:OFICINA 9-A
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680-4882
Practice Address - Country:US
Practice Address - Phone:787-832-3037
Practice Address - Fax:787-265-1895
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-12
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12625208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR12625OtherLICENCE
PR12625OtherLICENCE
PR0089640Medicare PIN