Provider Demographics
NPI:1518957166
Name:GONZALEZ, PAUL J (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:J
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:PO BOX 1527
Mailing Address - Street 2:
Mailing Address - City:ELFERS
Mailing Address - State:FL
Mailing Address - Zip Code:34680-1527
Mailing Address - Country:US
Mailing Address - Phone:727-842-9900
Mailing Address - Fax:727-844-5425
Practice Address - Street 1:3531 LITTLE RD
Practice Address - Street 2:
Practice Address - City:TRINITY
Practice Address - State:FL
Practice Address - Zip Code:34655-1811
Practice Address - Country:US
Practice Address - Phone:727-842-9900
Practice Address - Fax:727-844-5425
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-25
Last Update Date:2014-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME67843207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL066903200Medicaid
FLP00189718OtherRAILROAD MEDICARE INDIVID
FL51220OtherBCBS INDIVIDUAL
FL593371219OtherTAX ID
FL74767OtherBCBS GROUP#
FLDC7779OtherRAILROAD MEDICARE GROUP
FL51220AMedicare PIN
FL593371219OtherTAX ID
FLK4654Medicare ID - Type UnspecifiedMEICARE GROUP#
FLDC7779OtherRAILROAD MEDICARE GROUP