Provider Demographics
NPI:1891872909
Name:GONZALEZ, RAFAEL EUGENIO (MD)
Entity Type:Individual
Prefix:
First Name:RAFAEL
Middle Name:EUGENIO
Last Name:GONZALEZ
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:PO BOX 558750
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33255-8750
Mailing Address - Country:US
Mailing Address - Phone:305-663-8409
Mailing Address - Fax:305-663-8573
Practice Address - Street 1:3100 SW 62 AVENUE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33255
Practice Address - Country:US
Practice Address - Phone:305-663-8409
Practice Address - Fax:305-663-8573
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME54893207LP2900X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL036086400Medicaid
FL08784ZMedicare ID - Type Unspecified
E31284Medicare UPIN