Provider Demographics
NPI:1770504417
Name:GONZALES, PATRICK P (MD)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:P
Last Name:GONZALES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:MR
Other - First Name:PATRICIO
Other - Middle Name:P
Other - Last Name:GONZALES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:7400 DOCS GROVE CIR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-8010
Mailing Address - Country:US
Mailing Address - Phone:407-352-9717
Mailing Address - Fax:407-354-5425
Practice Address - Street 1:7400 DOCS GROVE CIR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-8010
Practice Address - Country:US
Practice Address - Phone:407-352-9717
Practice Address - Fax:407-354-5425
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2010-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0050007207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL038538700Medicaid
04147OtherBCBS
FL04147AMedicare ID - Type Unspecified
FL038538700Medicaid