| Entity Name: | PATRICK M. GONZALEZ, M.D., P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 20 Feb 1996 (29 years ago) |
| Document Number: | P96000015827 |
| FEI/EIN Number | 593362726 |
| Address: | 1420 SW SAINT LUCIE WEST BLVD, SUITE 102, PORT SAINT LUCIE, FL, 34986, US |
| Mail Address: | 1420 SW SAINT LUCIE WEST BLVD, SUITE 102, PORT SAINT LUCIE, FL, 34986, US |
| ZIP code: | 34986 |
| County: | St. Lucie |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1851606263 | 2010-08-10 | 2010-08-10 | 1420 SW SAINT LUCIE WEST BLVD, SUITE 102, PORT SAINT LUCIE, FL, 349861709, US | 1420 SW SAINT LUCIE WEST BLVD, SUITE 102, PORT SAINT LUCIE, FL, 349861709, US | |||||||||||||||||||||||||
|
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| Phone | +1 772-873-1005 |
| Fax | 7728739106 |
Authorized person
| Name | PATRICK M GONZALEZ |
| Role | OWNERR |
| Phone | 7728731005 |
Taxonomy
| Taxonomy Code | 208100000X - Physical Medicine & Rehabilitation Physician |
| License Number | ME 67553 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 377982300 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| GONZALEZ PATRICK MDr. | Agent | 1420 SW SAINT LUCIE WEST BLVD, PORT SAINT LUCIE, FL, 34986 |
| Name | Role | Address |
|---|---|---|
| GONZALEZ PATRICK M | President | 1208 SW LIVE OAK COVE, PORT ST LUCIE, FL, 349862005 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT NAME CHANGED | 2013-04-13 | GONZALEZ, PATRICK M, Dr. | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2004-03-20 | 1420 SW SAINT LUCIE WEST BLVD, SUITE 102, PORT SAINT LUCIE, FL 34986 | No data |
| CHANGE OF MAILING ADDRESS | 2004-03-20 | 1420 SW SAINT LUCIE WEST BLVD, SUITE 102, PORT SAINT LUCIE, FL 34986 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2004-03-20 | 1420 SW SAINT LUCIE WEST BLVD, STE 102, PORT SAINT LUCIE, FL 34986 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-26 |
| ANNUAL REPORT | 2023-03-21 |
| ANNUAL REPORT | 2022-03-08 |
| ANNUAL REPORT | 2021-03-20 |
| ANNUAL REPORT | 2020-02-29 |
| ANNUAL REPORT | 2019-04-02 |
| ANNUAL REPORT | 2018-03-24 |
| ANNUAL REPORT | 2017-03-12 |
| ANNUAL REPORT | 2016-03-25 |
| ANNUAL REPORT | 2015-03-14 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
