Provider Demographics
NPI:1548834120
Name:GONZALEZ, ALEXANDRO SAGOR (MD)
Entity type:Individual
Prefix:
First Name:ALEXANDRO
Middle Name:SAGOR
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20215 NW 2ND AVE, STE 1
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33169
Mailing Address - Country:US
Mailing Address - Phone:305-685-5688
Mailing Address - Fax:
Practice Address - Street 1:20215 NW 2ND AVE, STE 1
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33169
Practice Address - Country:US
Practice Address - Phone:305-685-5688
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-18
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR22792208D00000X
PR390200000X
FLACN1454208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program