Provider Demographics
NPI:1881645729
Name:GONZALEZ, JESUS JR (MD)
Entity Type:Individual
Prefix:DR
First Name:JESUS
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:PO BOX 190857
Mailing Address - Street 2:
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33119-0857
Mailing Address - Country:US
Mailing Address - Phone:305-534-6251
Mailing Address - Fax:305-667-5537
Practice Address - Street 1:1540 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33139-7801
Practice Address - Country:US
Practice Address - Phone:305-534-6251
Practice Address - Fax:305-667-5537
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 45503207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLC57724Medicare UPIN
FL96747Medicare ID - Type Unspecified