Individual
DR. GUSTAVO A GONZALEZ JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
801 S DOUGLAS RD, PEMBROKE PINES, FL 33025-1355
(954) 985-1470
Mailing address
14050 NW 14TH ST, SUITE 190, SUNRISE, FL 33323-2865
(800) 424-3672
(954) 377-3042
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
ME67840
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
27762
BLUE SHIELD
FL
05
—
379098300
—
FL
Enumeration date
06/23/2006
Last updated
03/14/2021
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