Provider Demographics
NPI:1003934365
Name:GOMEZ, FELIPE DE JESUS (MD)
Entity Type:Individual
Prefix:DR
First Name:FELIPE
Middle Name:DE JESUS
Last Name:GOMEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1605 E INTERSTATE HIGHWAY 2 STE D
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-6607
Mailing Address - Country:US
Mailing Address - Phone:956-585-1564
Mailing Address - Fax:956-585-2830
Practice Address - Street 1:1605 E INTERSTATE HIGHWAY 2
Practice Address - Street 2:STE D
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-6607
Practice Address - Country:US
Practice Address - Phone:956-362-3520
Practice Address - Fax:956-362-3529
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ4825207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX115387608Medicaid
TX115387609OtherMEDICAID-CSHCN
TX84170XOtherBCBS INDIVIDUAL NUMBER
TX84170XOtherBCBS INDIVIDUAL NUMBER
TX464852ZK0DMedicare PIN
TX115387609OtherMEDICAID-CSHCN