Provider Demographics
NPI:1518276146
Name:GONZALEZ VERGARA, FERNANDO (MD)
Entity Type:Individual
Prefix:DR
First Name:FERNANDO
Middle Name:
Last Name:GONZALEZ VERGARA
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 1:8050 N UNIVERSITY DR STE 101
Mailing Address - Street 2:
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33321-2102
Mailing Address - Country:US
Mailing Address - Phone:954-532-5160
Mailing Address - Fax:954-998-7307
Practice Address - Street 1:8050 N UNIVERSITY DR STE 101
Practice Address - Street 2:
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-2102
Practice Address - Country:US
Practice Address - Phone:954-532-5160
Practice Address - Fax:954-998-7307
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-30
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR28250207R00000X
FLME114208207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME114208OtherMEDICAL LICENCE