Provider Demographics
NPI:1982032561
Name:GONZALEZ VILLAMAN, COSME MIGUEL (MD)
Entity Type:Individual
Prefix:
First Name:COSME
Middle Name:MIGUEL
Last Name:GONZALEZ VILLAMAN
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:CALLE 53 SE, 870.
Mailing Address - Street 2:REPARTO METROPOLITANO, RIO PIEDRA
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00921
Mailing Address - Country:US
Mailing Address - Phone:787-605-7339
Mailing Address - Fax:
Practice Address - Street 1:CALLE 53 SE 870,
Practice Address - Street 2:REPARTO METROPOLITANO, RIO PIEDRAS
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921
Practice Address - Country:US
Practice Address - Phone:787-605-7339
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-17
Last Update Date:2013-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR223E207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery