Provider Demographics
NPI:1558305458
Name:GONZALEZ, EDUARDO JOAQUIN (MD)
Entity Type:Individual
Prefix:
First Name:EDUARDO
Middle Name:JOAQUIN
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 1:8200 SW 117TH AVE
Mailing Address - Street 2:SUITE # 114
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33183-3856
Mailing Address - Country:US
Mailing Address - Phone:305-271-5001
Mailing Address - Fax:305-271-6779
Practice Address - Street 1:8200 SW 117TH AVE
Practice Address - Street 2:SUITE # 114
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33183-3856
Practice Address - Country:US
Practice Address - Phone:305-271-5001
Practice Address - Fax:305-271-6779
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-15
Last Update Date:2010-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0039568207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL374602000Medicaid
FL96212AMedicare ID - Type Unspecified
FLD63776Medicare UPIN