Provider Demographics
NPI:1366638546
Name:GONZALEZ, FRANCISCO (PA)
Entity Type:Individual
Prefix:MR
First Name:FRANCISCO
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:FRANCISCO
Other - Middle Name:
Other - Last Name:GONZALEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA
Mailing Address - Street 1:1002 S. DILLARD STREET
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787
Mailing Address - Country:US
Mailing Address - Phone:407-877-3577
Mailing Address - Fax:407-877-8495
Practice Address - Street 1:1002 S DILLARD ST STE 102
Practice Address - Street 2:
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-3991
Practice Address - Country:US
Practice Address - Phone:407-877-3577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-20
Last Update Date:2015-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9100627363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL169181OtherFELLOW SHIP IN PROGRESS METABOLIC AND NUTRITIONAL MEDICINE
FL04166641OtherEDUCATIONAL COMMISSION FOR FOREIGN MEDICAL GRADUATE CERTIFICATION
FL539442194OtherAMERICAN DIABETES ASSOCIATION
FLME26402800100OtherAMA
FL9100627OtherPA, LICENSE