Provider Demographics
NPI:1205960085
Name:GONZALEZ, NERVIS A SR (MD)
Entity type:Individual
Prefix:MR
First Name:NERVIS
Middle Name:A
Last Name:GONZALEZ
Suffix:SR
Gender:M
Credentials:MD
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:AB21 CALLE 15 URB COLINAS DE MONTECARLO
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00924
Mailing Address - Country:US
Mailing Address - Phone:787-769-5309
Mailing Address - Fax:787-769-5309
Practice Address - Street 1:SECTOR BAIROA LA 25
Practice Address - Street 2:
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-745-0685
Practice Address - Fax:787-745-0410
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR11009208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice