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Organization
POTENCIANO GONZALES MD PA
Active
Organization
POTENCIANO GONZALES MD PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. POTENCIANO DIVINO GONZALES JR. MD (PHYSICIAN)
(386) 668-8559
Entity
Organization
Contact information
Practice address
62 SPRING VISTA DR STE 100, DEBARY, FL 32713-1812
(386) 668-8559
Mailing address
62 SPRING VISTA DR STE 101, DEBARY, FL 32713-1812
(386) 668-8559
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Enumeration date
01/29/2010
Last updated
09/30/2010
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