Provider Demographics
NPI:1972528420
Name:AGUILAR, GONZALO A (MD, PA)
Entity Type:Individual
Prefix:DR
First Name:GONZALO
Middle Name:A
Last Name:AGUILAR
Suffix:
Gender:M
Credentials:MD, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:580 W 8TH ST STE 6001
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32209-6533
Mailing Address - Country:US
Mailing Address - Phone:904-244-9995
Mailing Address - Fax:904-244-9007
Practice Address - Street 1:580 W 8TH ST STE 6001
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32209-6533
Practice Address - Country:US
Practice Address - Phone:904-244-9995
Practice Address - Fax:904-244-9007
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME003390174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL15541OtherBLUE CROSS BLUE SHIELD
FL216677OtherAVMED
FL210260OtherHEALTHEASE
FL216677OtherAVMED
FL15541OtherBLUE CROSS BLUE SHIELD