Provider Demographics
NPI:1619930682
Name:GONZALEZ CHAVEZ, JOSE RAMON (MD)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:RAMON
Last Name:GONZALEZ CHAVEZ
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:138 AVE WINSTON CHURCHILL
Mailing Address - Street 2:SUITE#423
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-6013
Mailing Address - Country:US
Mailing Address - Phone:787-460-0478
Mailing Address - Fax:787-761-4318
Practice Address - Street 1:SANTURCE MEDICAL MALL AVE.PONCE DE LEON 1801
Practice Address - Street 2:SUITE#302
Practice Address - City:SANTURCE
Practice Address - State:PR
Practice Address - Zip Code:00909
Practice Address - Country:US
Practice Address - Phone:787-727-0060
Practice Address - Fax:787-761-4318
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-10
Last Update Date:2014-10-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PR5737207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR26193OtherMEDICARE PROVIDER
PR27226OtherMEDICARE NUMBER
PR5737OtherSTATE LICENCE
PR26193OtherMEDICARE PROVIDER