Provider Demographics
NPI:1710972328
Name:GONZALEZ, RUBEN (MD)
Entity Type:Individual
Prefix:DR
First Name:RUBEN
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 1:11780 SW 89TH ST
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-2181
Mailing Address - Country:US
Mailing Address - Phone:305-260-9803
Mailing Address - Fax:305-260-9298
Practice Address - Street 1:11780 SW 89TH ST
Practice Address - Street 2:3RD FLOOR
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-2181
Practice Address - Country:US
Practice Address - Phone:305-260-9803
Practice Address - Fax:305-260-9298
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-20
Last Update Date:2023-02-27
Deactivation Date:2006-03-23
Deactivation Code:
Reactivation Date:2006-04-12
Provider Licenses
StateLicense IDTaxonomies
FLME42929174400000X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL043741700Medicaid
FLD64949Medicare UPIN
FLK2971Medicare ID - Type Unspecified