Provider Demographics
NPI:1043364011
Name:GOMEZ-VAZQUEZ FAMILY PRACTICE, PA
Entity Type:Organization
Organization Name:GOMEZ-VAZQUEZ FAMILY PRACTICE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:GOMEZ-VAZQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-722-8046
Mailing Address - Street 1:7210 MCPHERSON RD
Mailing Address - Street 2:SUITE #115
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041-6507
Mailing Address - Country:US
Mailing Address - Phone:956-722-8046
Mailing Address - Fax:956-722-8047
Practice Address - Street 1:7210 MCPHERSON RD
Practice Address - Street 2:SUITE #115
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-6507
Practice Address - Country:US
Practice Address - Phone:956-722-8046
Practice Address - Fax:956-722-8047
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ-4159207Q00000X
TXJ-4160207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00T38ZOtherBCBS GROUP #
TX1053470070OtherNPI
TX1013076058OtherNPI
TX00T38ZMedicare ID - Type UnspecifiedMEDICARE GROUP #