Provider Demographics
NPI:1659402840
Name:GONZALEZ, ALFREDO E (MD)
Entity Type:Individual
Prefix:
First Name:ALFREDO
Middle Name:E
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 1:201 N LAKEMONT AVE
Mailing Address - Street 2:SUITE 800
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-3208
Mailing Address - Country:US
Mailing Address - Phone:407-645-2737
Mailing Address - Fax:407-645-1082
Practice Address - Street 1:201 N LAKEMONT AVE
Practice Address - Street 2:SUITE 800
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-3208
Practice Address - Country:US
Practice Address - Phone:407-645-2737
Practice Address - Fax:407-645-1082
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2013-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME67354207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL593369175OtherTAX ID
FLE47976Medicare UPIN
FL26401Medicare ID - Type Unspecified