Provider Demographics
NPI:1467711325
Name:GONZALEZ MARTINEZ, JOSE LISANDRO (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:LISANDRO
Last Name:GONZALEZ MARTINEZ
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 1:7369 SHERIDAN ST STE 300
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33024-2776
Mailing Address - Country:US
Mailing Address - Phone:954-451-5932
Mailing Address - Fax:954-947-4351
Practice Address - Street 1:7369 SHERIDAN ST STE 300
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33024-2776
Practice Address - Country:US
Practice Address - Phone:954-451-5932
Practice Address - Fax:954-947-4351
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-14
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME148360207RG0100X
TX12-134246ZC0007X, 246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
No246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist