Provider Demographics
NPI:1518074558
Name:GONZALEZ, WILFREDO (MD)
Entity Type:Individual
Prefix:DR
First Name:WILFREDO
Middle Name:
Last Name:GONZALEZ
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 1:9851 NW 58TH ST UNIT 109
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33178-2717
Mailing Address - Country:US
Mailing Address - Phone:305-470-9002
Mailing Address - Fax:305-470-9934
Practice Address - Street 1:9851 NW 58TH ST UNIT 109
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33178-2717
Practice Address - Country:US
Practice Address - Phone:305-470-9002
Practice Address - Fax:305-470-9934
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME50720207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL047277800Medicaid
FL047277802Medicaid