Provider Demographics
NPI:1477529592
Name:GONZALEZ ARCE, ISMAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:ISMAEL
Middle Name:
Last Name:GONZALEZ ARCE
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:HC 01 BOX 7900
Mailing Address - Street 2:
Mailing Address - City:HATILLO
Mailing Address - State:PR
Mailing Address - Zip Code:00659-9706
Mailing Address - Country:US
Mailing Address - Phone:787-383-9775
Mailing Address - Fax:787-898-4590
Practice Address - Street 1:137 CALLE B
Practice Address - Street 2:BO CARRIZALES
Practice Address - City:HATILLO
Practice Address - State:PR
Practice Address - Zip Code:00659-1646
Practice Address - Country:US
Practice Address - Phone:787-898-4590
Practice Address - Fax:787-898-4590
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-28
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9688208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
10903OtherSES HORARIO EXT
P865OtherFIRST MEDICAL
100158OtherMMM
M9665OtherCRUZ ACUL
2866OtherPREFERRED
6590038OtherHUMANA
M9665OtherCRUZ ACUL
81848Medicare ID - Type UnspecifiedSSS