Space Coast Urology, LLC

Primary specialty

SpecialistTaxonomy code 174400000X

License

ME67177 Issued in FL

Legal business name

SPACE COAST UROLOGY, LLC

Practice address

2203 Garden St
Titusville, FL 32796-2577

Phone

(321) 268-4693

Fax

(321) 268-4696

NPI assigned

Oct 11, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Justo Gonzalez, M.D.NPI 1639204019

Title

Urologist

Phone

(321) 268-4693

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Justo Gonzalez, M.D. Doing business as

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Justo Gonzalez, M.D.

  • Specialist
  • Titusville, FL
  • NPI 1639204019
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1192060800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1236902400000",
    "number": "1336337690",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2203 GARDEN ST",
            "city": "TITUSVILLE",
            "state": "FL",
            "postal_code": "327962577",
            "telephone_number": "321-268-4693",
            "fax_number": "321-268-4696"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2203 GARDEN ST",
            "city": "TITUSVILLE",
            "state": "FL",
            "postal_code": "327962577",
            "telephone_number": "321-268-4693",
            "fax_number": "321-268-4696"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPACE COAST UROLOGY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-11",
        "last_updated": "2009-03-13",
        "status": "A",
        "authorized_official_last_name": "GONZALEZ",
        "authorized_official_first_name": "JUSTO",
        "authorized_official_title_or_position": "UROLOGIST",
        "authorized_official_telephone_number": "321-268-4693",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "FL",
            "license": "ME67177",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "271696800",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Justo Gonzalez, M.D.",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Space Coast Medical Center
• Space Coast Medical Consultants PLLC
• Space Coast Ophthalmology LLC
• Space Coast Pain Relief Inc.
• Space Coast Radiology Associates
• Jan L. Spagnoli, DDS
• Specialized Transportation for Outpatient Services, Inc.
• Specialized Treatment, Education and Prevention Services, Inc.
• Speechwise Therapy LLC
• Anita D Spitz, MD

• Specialist in Titusville, FL
• Providers in Titusville, FL by specialty
• Specialist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.