Provider Demographics
NPI:1710901095
Name:GONZALEZ, HORACIO (MD)
Entity Type:Individual
Prefix:DR
First Name:HORACIO
Middle Name:
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 1:1007 E ALTAMONTE DR
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32701-5005
Mailing Address - Country:US
Mailing Address - Phone:407-834-3730
Mailing Address - Fax:407-834-4863
Practice Address - Street 1:1007 E ALTAMONTE DR
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32701-5005
Practice Address - Country:US
Practice Address - Phone:407-834-3730
Practice Address - Fax:407-834-4863
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME41239174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME41239OtherFLORIDA MEDICAL LICENSE
FLME41239OtherFLORIDA MEDICAL LICENSE
36387AMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER