Provider Demographics
NPI:1821194382
Name:ECHAVARRIA, GONZALO (MD)
Entity Type:Individual
Prefix:
First Name:GONZALO
Middle Name:
Last Name:ECHAVARRIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:804 SCOTT NIXON MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30907-2464
Mailing Address - Country:US
Mailing Address - Phone:800-394-4445
Mailing Address - Fax:706-868-4488
Practice Address - Street 1:12230 W FOREST HILL BLVD
Practice Address - Street 2:STE #182
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-5700
Practice Address - Country:US
Practice Address - Phone:561-798-4221
Practice Address - Fax:561-798-4201
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME94847207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAC685ZMedicare PIN