Provider Demographics
NPI:1427390137
Name:GONZALEZ, JORGE ANTONIO JR (MD)
Entity Type:Individual
Prefix:DR
First Name:JORGE
Middle Name:ANTONIO
Last Name:GONZALEZ
Suffix:JR
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 1:3333 W COMMERCIAL BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33309-3424
Mailing Address - Country:US
Mailing Address - Phone:954-751-6990
Mailing Address - Fax:954-751-6991
Practice Address - Street 1:3333 W COMMERCIAL BLVD STE 101
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33309-3424
Practice Address - Country:US
Practice Address - Phone:954-751-6990
Practice Address - Fax:954-751-6991
Is Sole Proprietor?:No
Enumeration Date:2013-03-20
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME128315207RS0010X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RS0010XAllopathic & Osteopathic PhysiciansInternal MedicineSports Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL017619600Medicaid
FL017619600Medicaid
FLIP415ZMedicare PIN