Provider Demographics
NPI:1710180211
Name:GONZALEZ, ERIC M (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:M
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 AVE HOSTOS
Mailing Address - Street 2:PH-3 COND. EL MONTE SUR
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918-4638
Mailing Address - Country:US
Mailing Address - Phone:787-759-8234
Mailing Address - Fax:787-740-4343
Practice Address - Street 1:100 AVE LAUREL
Practice Address - Street 2:SANTA JUANITA
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00956-4816
Practice Address - Country:US
Practice Address - Phone:787-740-3555
Practice Address - Fax:787-740-4343
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7778208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR7778OtherPR MEDICAL LICENSE