Provider Demographics
NPI:1508892068
Name:GONZALEZ-ROTHI, RICARDO J (MD)
Entity Type:Individual
Prefix:DR
First Name:RICARDO
Middle Name:J
Last Name:GONZALEZ-ROTHI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:RICARDO
Other - Middle Name:J
Other - Last Name:GONZALEZ-ROTHI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1115 W CALL ST
Mailing Address - Street 2:SUITE 3140-D CLINICAL SCIENCES
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32304-3556
Mailing Address - Country:US
Mailing Address - Phone:850-645-9732
Mailing Address - Fax:850-644-0158
Practice Address - Street 1:1115 W CALL ST
Practice Address - Street 2:SUITE 3140-D CLINICAL SCIENCES
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32304-3556
Practice Address - Country:US
Practice Address - Phone:850-645-9732
Practice Address - Fax:850-644-0158
Is Sole Proprietor?:No
Enumeration Date:2006-06-24
Last Update Date:2013-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME36653207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL066404900Medicaid
FL68268ZMedicare PIN
FL066404900Medicaid