Provider Demographics
NPI:1710971460
Name:GONZALEZ-NAVEDO, EDWIN (MD)
Entity Type:Individual
Prefix:MR
First Name:EDWIN
Middle Name:
Last Name:GONZALEZ-NAVEDO
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 1:3140 NW MEDICAL CENTER LN
Mailing Address - Street 2:SUITE 120
Mailing Address - City:LAKE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32055-4717
Mailing Address - Country:US
Mailing Address - Phone:386-755-6682
Mailing Address - Fax:386-755-6796
Practice Address - Street 1:3140 NW MEDICAL CENTER LN
Practice Address - Street 2:SUITE 120
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32055-4717
Practice Address - Country:US
Practice Address - Phone:386-755-6682
Practice Address - Fax:386-755-6796
Is Sole Proprietor?:No
Enumeration Date:2005-09-08
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME92298208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL271874000Medicaid
FLC82236Medicare UPIN
FL271874000Medicaid