Provider Demographics
NPI:1720187610
Name:GONZALEZ-GOMEZ, IGNACIO (MD)
Entity Type:Individual
Prefix:
First Name:IGNACIO
Middle Name:
Last Name:GONZALEZ-GOMEZ
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 1:501 6TH AVE S
Mailing Address - Street 2:BOX 6941
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-4634
Mailing Address - Country:US
Mailing Address - Phone:727-767-4429
Mailing Address - Fax:727-767-4970
Practice Address - Street 1:501 6TH AVE S
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-4634
Practice Address - Country:US
Practice Address - Phone:727-767-4341
Practice Address - Fax:727-767-8516
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2010-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME104028207ZP0213X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0213XAllopathic & Osteopathic PhysiciansPathologyPediatric Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1981246OtherCIGNA
FL1454HOtherBLUE CROSS/BLUE SHIELD
FL294635OtherSTAYWELL/HEALTHEASE
CA00A670490Medicaid
FL331553OtherAVMED
FL000782800Medicaid
FL7913502OtherAETNA
FL1981246OtherCIGNA
CA00A670490Medicaid