Provider Demographics
NPI:1629087614
Name:C F GONZALEZ MD PA
Entity Type:Organization
Organization Name:C F GONZALEZ MD PA
Other - Org Name:SUGARMILL MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MD PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:F
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-382-8282
Mailing Address - Street 1:PO BOX 3749
Mailing Address - Street 2:
Mailing Address - City:HOMOSASSA SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34447
Mailing Address - Country:US
Mailing Address - Phone:352-382-8282
Mailing Address - Fax:352-382-2289
Practice Address - Street 1:7991 S SUNCOAST BLVD
Practice Address - Street 2:
Practice Address - City:HOMOSASSA
Practice Address - State:FL
Practice Address - Zip Code:34446
Practice Address - Country:US
Practice Address - Phone:352-382-8282
Practice Address - Fax:352-382-2289
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-07
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL45107OtherBC/BS FLORIDA
FL049771100Medicaid
FL049771100Medicaid
FL09016VMedicare ID - Type Unspecified