Provider Demographics
NPI:1598866683
Name:ROBERT T GONZALEZ, MD,FAAP,PA
Entity Type:Organization
Organization Name:ROBERT T GONZALEZ, MD,FAAP,PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MAYRA
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-433-1825
Mailing Address - Street 1:2301 N UNIVERSITY DR
Mailing Address - Street 2:SUITE 202
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33024-3617
Mailing Address - Country:US
Mailing Address - Phone:954-433-1825
Mailing Address - Fax:954-433-1827
Practice Address - Street 1:2301 N UNIVERSITY DR
Practice Address - Street 2:SUITE 202
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33024-3617
Practice Address - Country:US
Practice Address - Phone:954-433-1825
Practice Address - Fax:954-433-1827
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2017-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME53651208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty