Provider Demographics
NPI:1407409386
Name:GONZALEZ VALLES, ALEXIS ROBERTO (MD)
Entity Type:Individual
Prefix:DR
First Name:ALEXIS
Middle Name:ROBERTO
Last Name:GONZALEZ VALLES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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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:321-332-6947
Mailing Address - Fax:407-286-4515
Practice Address - Street 1:1931 S NARCOOSSEE RD
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:FL
Practice Address - Zip Code:34771-7211
Practice Address - Country:US
Practice Address - Phone:407-986-9642
Practice Address - Fax:407-593-6102
Is Sole Proprietor?:No
Enumeration Date:2019-07-19
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR21503208D00000X
FLACN1234208D00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLFG8609503OtherGENERAL PRACTICE