Organization
LEOPOLDO B GONZALEZ MD PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LEOPOLDO B GONZALEZ MDPA (OWNER)
(904) 824-4277
Entity
Organization
Contact information
Practice address
301 HEALTH PARK BLVD, SUITE 323, ST AUGUSTINE, FL 32086-5793
(904) 824-4277
(904) 824-4490
Mailing address
301 HEALTH PARK BLVD, SUITE 323, ST AUGUSTINE, FL 32086-5793
(904) 824-4277
(904) 824-4490
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
ME0022097
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
054187700
—
FL
Enumeration date
08/14/2008
Last updated
02/18/2009
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