Provider Demographics
NPI:1851307037
Name:GONZALEZ, BISMARK FRANCISCO (MD)
Entity Type:Individual
Prefix:DR
First Name:BISMARK
Middle Name:FRANCISCO
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 1:7800 SW 87TH AVE STE C-350
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-3570
Mailing Address - Country:US
Mailing Address - Phone:305-238-2262
Mailing Address - Fax:305-235-9096
Practice Address - Street 1:7800 SW 87TH AVE STE C-350
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-3570
Practice Address - Country:US
Practice Address - Phone:305-238-2262
Practice Address - Fax:305-235-9096
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2023-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME62724208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL373315701Medicaid
FLF54138Medicare UPIN