Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086X0206X | Surgical Oncologist | ME102674 | FL |
NPI | 1275632929 |
---|---|
Provider Name | Ricardo J. Gonzalez |
First Address | Tampa, FL 33612 |
Second Address | Tampa, FL 33612 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/09/2006 |
Last Update Date | 26/03/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000130200 | (05) | FL |