Provider Demographics
NPI:1952593634
Name:GONZALEZ-RODRIGUEZ, ANGEL R (MD)
Entity Type:Individual
Prefix:DR
First Name:ANGEL
Middle Name:R
Last Name:GONZALEZ-RODRIGUEZ
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 1:38135 MARKET SQ
Mailing Address - Street 2:
Mailing Address - City:ZEPHYRHILLS
Mailing Address - State:FL
Mailing Address - Zip Code:33542-7505
Mailing Address - Country:US
Mailing Address - Phone:352-567-0188
Mailing Address - Fax:
Practice Address - Street 1:36763 EILAND BLVD STE 201
Practice Address - Street 2:
Practice Address - City:ZEPHYRHILLS
Practice Address - State:FL
Practice Address - Zip Code:33542-0600
Practice Address - Country:US
Practice Address - Phone:813-528-4843
Practice Address - Fax:813-355-5052
Is Sole Proprietor?:No
Enumeration Date:2007-08-15
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1034602084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001068600Medicaid
FLP00792563OtherRR MEDICARE
FLCA742Y- TPAMedicare PIN
FL001068600Medicaid