Provider Demographics
NPI:1801039938
Name:GONZALEZ, PEDRO (PA)
Entity Type:Individual
Prefix:DR
First Name:PEDRO
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1259 BLUEBIRD AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33166-3117
Mailing Address - Country:US
Mailing Address - Phone:305-275-7029
Mailing Address - Fax:305-275-7066
Practice Address - Street 1:1259 BLUEBIRD AVE
Practice Address - Street 2:
Practice Address - City:MIAMI SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33166-3117
Practice Address - Country:US
Practice Address - Phone:305-275-7029
Practice Address - Fax:305-275-7066
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-20
Last Update Date:2009-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9100617207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE5656ZMedicare Oscar/Certification