Provider Demographics
NPI:1275591489
Name:GONZALEZ GONZALEZ, ROBERTO (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERTO
Middle Name:
Last Name:GONZALEZ 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 7214
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00732-7214
Mailing Address - Country:US
Mailing Address - Phone:787-844-5980
Mailing Address - Fax:787-844-5999
Practice Address - Street 1:SALUD AVE. #1326
Practice Address - Street 2:SUITE 511
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-1689
Practice Address - Country:US
Practice Address - Phone:787-844-5980
Practice Address - Fax:787-844-5999
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-04
Last Update Date:2013-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6432207YX0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & Neck
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0098283Medicare ID - Type Unspecified
PRD26703Medicare UPIN