Provider Demographics
NPI:1487608840
Name:GONZALEZ, RAFAEL (MD)
Entity type:Individual
Prefix:DR
First Name:RAFAEL
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14332 SW 40TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-7823
Mailing Address - Country:US
Mailing Address - Phone:305-633-3776
Mailing Address - Fax:305-633-4240
Practice Address - Street 1:1479 NW 27TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-2133
Practice Address - Country:US
Practice Address - Phone:305-633-3776
Practice Address - Fax:305-633-4240
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2007-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME89042208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME89042OtherFL MEDICAL LICENSE
FLU0066DMedicare PIN
FLME89042OtherFL MEDICAL LICENSE