Provider Demographics
NPI:1801193701
Name:GONZALEZ, MANUEL OCTAVIO (MD)
Entity Type:Individual
Prefix:DR
First Name:MANUEL
Middle Name:OCTAVIO
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:6050 W 20TH AVE FL 3
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-2605
Mailing Address - Country:US
Mailing Address - Phone:786-584-5555
Mailing Address - Fax:786-584-5050
Practice Address - Street 1:6050 W 20TH AVE FL 3
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-2605
Practice Address - Country:US
Practice Address - Phone:786-584-5555
Practice Address - Fax:786-584-5050
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-12
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY262848207RG0100X
FLME138174207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology