Provider Demographics
NPI:1235453580
Name:MANUEL D GONZALEZ MD PA
Entity Type:Organization
Organization Name:MANUEL D GONZALEZ MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MANUEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD PA
Authorized Official - Phone:305-987-1007
Mailing Address - Street 1:2141 NW 7TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33125-3483
Mailing Address - Country:US
Mailing Address - Phone:305-987-1007
Mailing Address - Fax:305-702-9442
Practice Address - Street 1:2141 NW 7TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-3483
Practice Address - Country:US
Practice Address - Phone:305-987-1007
Practice Address - Fax:305-702-9442
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-16
Last Update Date:2021-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME103534174400000X
207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty