Provider Demographics
NPI:1740278613
Name:GONZALEZ ANDUJAR, DORMA (MD)
Entity type:Individual
Prefix:
First Name:DORMA
Middle Name:
Last Name:GONZALEZ ANDUJAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:HC 1 BOX 1044B
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00612-9713
Mailing Address - Country:US
Mailing Address - Phone:787-462-2091
Mailing Address - Fax:787-650-2340
Practice Address - Street 1:49 CALLE MUNOZ RIVERA
Practice Address - Street 2:
Practice Address - City:JUNCOS
Practice Address - State:PR
Practice Address - Zip Code:00777-3112
Practice Address - Country:US
Practice Address - Phone:787-743-0525
Practice Address - Fax:787-561-0742
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-13
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR16164208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice