Provider Demographics
NPI:1689658809
Name:GONZALEZ, JAVIER M (MD)
Entity Type:Individual
Prefix:
First Name:JAVIER
Middle Name:M
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:308 W HIGHLAND BLVD
Mailing Address - Street 2:
Mailing Address - City:INVERNESS
Mailing Address - State:FL
Mailing Address - Zip Code:34452-4716
Mailing Address - Country:US
Mailing Address - Phone:352-726-8353
Mailing Address - Fax:352-726-5038
Practice Address - Street 1:910 OLD CAMP RD
Practice Address - Street 2:BLDG 210
Practice Address - City:THE VILLAGES
Practice Address - State:FL
Practice Address - Zip Code:32162-5604
Practice Address - Country:US
Practice Address - Phone:352-751-3356
Practice Address - Fax:352-751-3359
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2013-03-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME83005207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0405694OtherCIGNA
FLME83005OtherSTATE LICENSE NUMBER
FL03015OtherBCBS OF FL
FLCF1416OtherMEDICARE RR GROUP
FL77940OtherMEDICARE GROUP ID
FL11319381OtherCAQH
FL263252700Medicaid
FL77940OtherBCBS GRP
FL269859500OtherMEDICAID GROUP
FL060065353OtherMEDICARE RR
FL11319381OtherCAQH
FL77940OtherMEDICARE GROUP ID