Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0402X | Child Neurologist | ME78708 | FL |
NPI | 1073545802 |
---|---|
Provider Name | Dr. Renato Gonik |
First Address | Gainesville, FL 32608-7448 |
Second Address | Gainesville, FL 32641-7516 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/07/2006 |
Last Update Date | 13/04/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
019925100 | (05) | FL |
261697100 | (05) | FL |