Provider Demographics
NPI:1700874625
Name:GONZALEZ, FELIX J (MD)
Entity Type:Individual
Prefix:DR
First Name:FELIX
Middle Name:J
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:PO BOX 557457
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33255-7457
Mailing Address - Country:US
Mailing Address - Phone:305-223-9938
Mailing Address - Fax:805-554-8288
Practice Address - Street 1:3850 SW 87TH AVE
Practice Address - Street 2:STE 104
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-5400
Practice Address - Country:US
Practice Address - Phone:305-223-9938
Practice Address - Fax:805-554-8288
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-13
Last Update Date:2010-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME44692207R00000X
FLME4692207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0440582-00Medicaid
02116Medicare ID - Type Unspecified
FL0440582-00Medicaid