Provider Demographics
NPI:1033129028
Name:GOMEZ, ROBERT ALAN (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:ALAN
Last Name:GOMEZ
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:P.O. BOX 1483
Mailing Address - Street 2:
Mailing Address - City:ALAMO
Mailing Address - State:CA
Mailing Address - Zip Code:94507
Mailing Address - Country:US
Mailing Address - Phone:707-649-1111
Mailing Address - Fax:707-649-1045
Practice Address - Street 1:1460 NORTH CAMINO ALTO
Practice Address - Street 2:SUITE 210
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94589-2567
Practice Address - Country:US
Practice Address - Phone:707-649-1111
Practice Address - Fax:707-649-1045
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2018-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG68196207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
F96356Medicare UPIN
ZZZ83455ZMedicare ID - Type Unspecified