Provider Demographics
NPI:1366678674
Name:F. JORGE GONZALEZ M.D PA
Entity Type:Organization
Organization Name:F. JORGE GONZALEZ M.D PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FLORENCIO
Authorized Official - Middle Name:JORGE
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-447-1628
Mailing Address - Street 1:2902 N ORANGE AVE
Mailing Address - Street 2:L
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804-4605
Mailing Address - Country:US
Mailing Address - Phone:407-447-1628
Mailing Address - Fax:321-422-4651
Practice Address - Street 1:2902 N ORANGE AVE
Practice Address - Street 2:L
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-4605
Practice Address - Country:US
Practice Address - Phone:407-447-1628
Practice Address - Fax:321-422-4651
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-02
Last Update Date:2009-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0079378261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty