Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | ME30162 | FL |
NPI | 1013903178 |
---|---|
Provider Name | Carlos Julio Gonzalez |
First Address | Tampa, FL 33634-7329 |
Second Address | Lake Placid, FL 33852-7948 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/09/2005 |
Last Update Date | 15/08/2007 |