Provider Demographics
NPI:1316197668
Name:GONZALEZ, ROBERTO RAUL (MD)
Entity Type:Individual
Prefix:
First Name:ROBERTO
Middle Name:RAUL
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 1:3850 W. FLAGLER ST.
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33134-1604
Mailing Address - Country:US
Mailing Address - Phone:305-774-3400
Mailing Address - Fax:305-442-0482
Practice Address - Street 1:3850 W. FLAGLER ST.
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33134-1604
Practice Address - Country:US
Practice Address - Phone:305-774-3400
Practice Address - Fax:305-442-0482
Is Sole Proprietor?:No
Enumeration Date:2008-09-23
Last Update Date:2013-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN47075207Q00000X
TXBP10028868390200000X
FLME114294207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program