Provider Demographics
NPI:1487848776
Name:ALBERTO GONZALEZ GOMEZ MD PA
Entity Type:Organization
Organization Name:ALBERTO GONZALEZ GOMEZ MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALBERTO
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ GOMEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-445-9330
Mailing Address - Street 1:5200 SW 8TH ST
Mailing Address - Street 2:SUITE 204B
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-2300
Mailing Address - Country:US
Mailing Address - Phone:305-445-9330
Mailing Address - Fax:305-448-6448
Practice Address - Street 1:5200 SW 8TH ST
Practice Address - Street 2:SUITE 204B
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-2300
Practice Address - Country:US
Practice Address - Phone:305-445-9330
Practice Address - Fax:305-448-6448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-30
Last Update Date:2007-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME91892208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU4349ZMedicare PIN
FLI26581Medicare UPIN
FLK7283Medicare PIN