Provider Demographics
NPI:1265827158
Name:GONZALEZ-O'FARRILL, ERICK (MD)
Entity Type:Individual
Prefix:
First Name:ERICK
Middle Name:
Last Name:GONZALEZ-O'FARRILL
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 1:176 MALLEY COVE LN
Mailing Address - Street 2:
Mailing Address - City:FLEMING ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32003-6104
Mailing Address - Country:US
Mailing Address - Phone:718-963-7272
Mailing Address - Fax:
Practice Address - Street 1:1309 N FLAGLER DR
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-3406
Practice Address - Country:US
Practice Address - Phone:561-882-4541
Practice Address - Fax:561-650-6093
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-30
Last Update Date:2019-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME131288207R00000X
282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine