Provider Demographics
NPI:1912231853
Name:EBRAN-GONZALEZ, RAUL (MD)
Entity Type:Individual
Prefix:
First Name:RAUL
Middle Name:
Last Name:EBRAN-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 1:8504 NW 103RD ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33016-4870
Mailing Address - Country:US
Mailing Address - Phone:786-420-5111
Mailing Address - Fax:305-901-1716
Practice Address - Street 1:8504 NW 103RD ST
Practice Address - Street 2:
Practice Address - City:HIALEAH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33016-4870
Practice Address - Country:US
Practice Address - Phone:786-420-5111
Practice Address - Fax:305-901-1716
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-24
Last Update Date:2020-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME115255207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL015355500Medicaid
FLME115255OtherFLORIDA MEDICAL LICENSE