Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RR0500X | Rheumatology | ME0064790 | FL |
NPI | 1033220744 |
---|---|
Provider Name | Miguel A Gonzalez |
First Address | Leesburg, FL 34749-1300 |
Second Address | Leesburg, FL 34788 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 09/06/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G32640 | (02) |