Provider Demographics
NPI:1033386131
Name:GOMEZ, MARIO A (MD)
Entity Type:Individual
Prefix:MR
First Name:MARIO
Middle Name:A
Last Name:GOMEZ
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:925 NE 30TH TER
Mailing Address - Street 2:SUITE 300
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33033-7614
Mailing Address - Country:US
Mailing Address - Phone:786-377-2500
Mailing Address - Fax:786-377-2501
Practice Address - Street 1:925 NE 30TH TER
Practice Address - Street 2:SUITE 300
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33033-7614
Practice Address - Country:US
Practice Address - Phone:786-377-2500
Practice Address - Fax:786-377-2501
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-08
Last Update Date:2011-08-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME102113207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001046400Medicaid
FLBW677XMedicare UPIN