Provider Demographics
NPI:1962490219
Name:GONZALEZ-INGLES, LUIS BENJAMIN (MD)
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:BENJAMIN
Last Name:GONZALEZ-INGLES
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:D-5 ST. 2 VISTA BELLA
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00956
Mailing Address - Country:US
Mailing Address - Phone:787-798-6043
Mailing Address - Fax:787-798-6043
Practice Address - Street 1:J16 CALLE 2 VILLA RICA
Practice Address - Street 2:EDIFICIO MEDICO HERMANAS DAVILA SUITE 108
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959
Practice Address - Country:US
Practice Address - Phone:787-288-2255
Practice Address - Fax:787-288-2255
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-11
Last Update Date:2015-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13308207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR20372Medicare ID - Type Unspecified
PRI05890Medicare UPIN