Provider Demographics
NPI:1285638171
Name:LOVEDAY, GONZALO J (MD)
Entity Type:Individual
Prefix:
First Name:GONZALO
Middle Name:J
Last Name:LOVEDAY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:600 UNIVERSITY BLVD
Mailing Address - Street 2:200
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-2778
Mailing Address - Country:US
Mailing Address - Phone:561-627-2210
Mailing Address - Fax:561-627-2130
Practice Address - Street 1:600 UNIVERSITY BLVD
Practice Address - Street 2:200
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-2778
Practice Address - Country:US
Practice Address - Phone:561-627-2210
Practice Address - Fax:561-627-2130
Is Sole Proprietor?:No
Enumeration Date:2005-06-08
Last Update Date:2011-08-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME98727207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM93957700Medicaid
NM93957700Medicaid
H82457Medicare UPIN