Potenciano Gonzales MD PA

NPI #1043541162 in Debary, Florida

Provider Information

NPI Number: 1043541162
Entity Type: Organization
Organization Name: Potenciano Gonzales MD PA
Primary Specialty: Family Medicine
Enumeration Date: Jan 29, 2010
Last Updated: Sep 30, 2010

Practice Location

Address: 62 SPRING VISTA DR STE 100
City: Debary
State: Florida
ZIP Code: 32713-1812
Phone: (386) 668-8559

Authorized Official

Name: DR. POTENCIANO DIVINO GONZALES JR., MD
Title: PHYSICIAN
Phone: (386) 668-8559

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Family Medicine	207Q00000X	Primary

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