Provider Demographics
NPI:1881752616
Name:GONZALEZ, EDUARDO LUIS (MD)
Entity type:Individual
Prefix:DR
First Name:EDUARDO
Middle Name:LUIS
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4400 E HIGHWAY 20 STE 209
Mailing Address - Street 2:
Mailing Address - City:NICEVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32578-7700
Mailing Address - Country:US
Mailing Address - Phone:850-389-8091
Mailing Address - Fax:850-389-8092
Practice Address - Street 1:4400 E HIGHWAY 20 STE 209
Practice Address - Street 2:
Practice Address - City:NICEVILLE
Practice Address - State:FL
Practice Address - Zip Code:32578-7700
Practice Address - Country:US
Practice Address - Phone:850-389-8091
Practice Address - Fax:850-389-8092
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2014-08-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME102584207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine