Provider Demographics
NPI:1033174644
Name:GOMEZ-MADRAZO, EMILIO J (MD)
Entity Type:Individual
Prefix:DR
First Name:EMILIO
Middle Name:J
Last Name:GOMEZ-MADRAZO
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 1:6280 SUNSET DR STE 408
Mailing Address - Street 2:
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-4860
Mailing Address - Country:US
Mailing Address - Phone:305-441-7999
Mailing Address - Fax:305-441-8020
Practice Address - Street 1:6280 SUNSET DR STE 408
Practice Address - Street 2:
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-4860
Practice Address - Country:US
Practice Address - Phone:305-441-7999
Practice Address - Fax:305-441-8020
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2015-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME67905207VG0400X, 207VF0040X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VF0040XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyFemale Pelvic Medicine and Reconstructive Surgery
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL250913000Medicaid
FLBC538OtherMEDICARE ID
FLBC538OtherMEDICARE ID
FLC77548Medicare UPIN