Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QG0300X | Family Doctor - Geriatric Medicine | 01063687A | IN |
NPI | 1164637674 |
---|---|
Provider Name | Dr. Jose Edwardo Gonzalez |
First Address | Doral, FL 33166-6202 |
Second Address | Miami, FL 33186-1829 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2007 |
Last Update Date | 15/01/2021 |