Individual
JASON ROBERTO GONZALEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3401 N BROAD ST, PHILADELPHIA, PA 19140-5103
(215) 707-5435
Mailing address
3401 N BROAD ST, PHILADELPHIA, PA 19140-5103
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
MT220457
PA
Other
Enumeration date
06/10/2020
Last updated
06/10/2020
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