Provider Demographics
NPI:1679536189
Name:GONZALEZ, JOSE NOEL (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:NOEL
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 1:5040 NW 7TH ST STE 530
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-3432
Mailing Address - Country:US
Mailing Address - Phone:305-995-0140
Mailing Address - Fax:305-995-0144
Practice Address - Street 1:5040 NW 7TH ST STE 530
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-3432
Practice Address - Country:US
Practice Address - Phone:305-995-0141
Practice Address - Fax:305-995-0144
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-07
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL55652207Q00000X
FLME0055652207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL254267600Medicaid
FLF00123Medicare UPIN