Provider Demographics
NPI:1356584361
Name:GONZALEZ, MANUEL D (MD)
Entity type:Individual
Prefix:
First Name:MANUEL
Middle Name:D
Last Name: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 1:2141 NW 7TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33125-3483
Mailing Address - Country:US
Mailing Address - Phone:786-464-5120
Mailing Address - Fax:786-464-5125
Practice Address - Street 1:2141 NW 7TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-3483
Practice Address - Country:US
Practice Address - Phone:786-464-5120
Practice Address - Fax:786-464-5125
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-07
Last Update Date:2021-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME103534207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine