Provider Demographics
NPI:1891794434
Name:GONZALEZ-INCLAN, JOSE RAUL (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:RAUL
Last Name:GONZALEZ-INCLAN
Suffix:
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:H6 CALLE BUCARE
Mailing Address - Street 2:
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00968-3116
Mailing Address - Country:US
Mailing Address - Phone:787-751-4197
Mailing Address - Fax:787-764-1828
Practice Address - Street 1:735 AVE PONCE DE LEON
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00917-5025
Practice Address - Country:US
Practice Address - Phone:787-751-4197
Practice Address - Fax:787-764-1828
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5954208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRE31243Medicare UPIN
PR27407Medicare ID - Type Unspecified