Provider Demographics
NPI:1417932617
Name:GONZALEZ ROMERO, EDGARDO (MD)
Entity Type:Individual
Prefix:MR
First Name:EDGARDO
Middle Name:
Last Name:GONZALEZ ROMERO
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:PO BOX 1821
Mailing Address - Street 2:
Mailing Address - City:MOCA
Mailing Address - State:PR
Mailing Address - Zip Code:00676-1821
Mailing Address - Country:US
Mailing Address - Phone:787-896-4552
Mailing Address - Fax:787-896-4552
Practice Address - Street 1:CALLE EMILIO RUIZ
Practice Address - Street 2:NUM 32 ALTOS
Practice Address - City:SAN SEBASTIAN
Practice Address - State:PR
Practice Address - Zip Code:00685-0000
Practice Address - Country:US
Practice Address - Phone:787-896-4552
Practice Address - Fax:787-896-4552
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-09
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11294207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRG03002Medicare UPIN