Provider Demographics
NPI:1669652566
Name:GONZALEZ, NELSON L (DPM)
Entity Type:Individual
Prefix:DR
First Name:NELSON
Middle Name:L
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5331 SW 8TH ST
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-2269
Mailing Address - Country:US
Mailing Address - Phone:786-534-6475
Mailing Address - Fax:786-558-9845
Practice Address - Street 1:5331 SW 8TH ST
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-2269
Practice Address - Country:US
Practice Address - Phone:786-534-6475
Practice Address - Fax:786-558-9845
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-07
Last Update Date:2017-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO3291213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL026269400Medicaid
FLBK498ZOtherMEDICARE PTAN