Provider Demographics
NPI:1386023463
Name:GONZALEZ, JONATHAN (MD)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:
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 1:6900 TAVISTOCK LAKES BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32827-7592
Mailing Address - Country:US
Mailing Address - Phone:904-745-3618
Mailing Address - Fax:904-722-4271
Practice Address - Street 1:14444 BEACH BLVD STE 28
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32250-2080
Practice Address - Country:US
Practice Address - Phone:904-367-2277
Practice Address - Fax:904-421-3788
Is Sole Proprietor?:No
Enumeration Date:2015-05-22
Last Update Date:2023-01-26
Deactivation Date:2021-10-26
Deactivation Code:
Reactivation Date:2021-11-05
Provider Licenses
StateLicense IDTaxonomies
OH35.131986207Q00000X
FLME134024207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine