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Individual

PATRICK M. GONZALEZ

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
1420 SW SAINT LUCIE WEST BLVD, SUITE 102, PORT ST LUCIE, FL 34986-1709
(772) 873-1005
(772) 873-9106
Mailing address
1420 SW SAINT LUCIE WEST BLVD, SUITE 102, PORT ST LUCIE, FL 34986-1709
(772) 873-1005
(772) 873-9106

Taxonomy

Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
ME 67553
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
377982300
FL
01
59-3362726
EMPLOYER INDENTIF. NUMBER
FL
Enumeration date
08/18/2006
Last updated
06/22/2010
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