Provider Demographics
NPI:1780640607
Name:GONZALEZ, MANUEL JR (MD)
Entity Type:Individual
Prefix:DR
First Name:MANUEL
Middle Name:
Last Name:GONZALEZ
Suffix:JR
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 1:7000 SW 97TH AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-1474
Mailing Address - Country:US
Mailing Address - Phone:305-662-7234
Mailing Address - Fax:305-662-7236
Practice Address - Street 1:7000 SW 97TH AVE STE 110
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-1474
Practice Address - Country:US
Practice Address - Phone:305-662-7234
Practice Address - Fax:305-662-7236
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME76871207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL44774WOtherMEDICARE ID
FL259714400Medicaid
FL44774XOtherMEDICARE ID
FL44774XOtherMEDICARE ID