Provider Demographics
NPI:1740844653
Name:GONZALEZ, ARIEL (MD)
Entity type:Individual
Prefix:
First Name:ARIEL
Middle Name:
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 1:1739 SW 67TH CIR
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32607
Mailing Address - Country:US
Mailing Address - Phone:651-600-6198
Mailing Address - Fax:
Practice Address - Street 1:5964 US HIGHWAY 90
Practice Address - Street 2:
Practice Address - City:LIVE OAK
Practice Address - State:FL
Practice Address - Zip Code:32060
Practice Address - Country:US
Practice Address - Phone:386-963-6685
Practice Address - Fax:386-963-6377
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-25
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR023893208D00000X
390200000X
FLACN1652208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program