Provider Demographics
NPI:1053460360
Name:EDUARDO G GOMEZ MD PA
Entity Type:Organization
Organization Name:EDUARDO G GOMEZ MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDUARDO
Authorized Official - Middle Name:G
Authorized Official - Last Name:GOMEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD PA
Authorized Official - Phone:305-556-7416
Mailing Address - Street 1:1840 W 49TH ST
Mailing Address - Street 2:SUITE 607
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-2942
Mailing Address - Country:US
Mailing Address - Phone:305-556-7416
Mailing Address - Fax:305-824-0879
Practice Address - Street 1:1840 W 49TH ST
Practice Address - Street 2:SUITE 607
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-2942
Practice Address - Country:US
Practice Address - Phone:305-556-7416
Practice Address - Fax:305-824-0879
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2013-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME0035412OtherMEDICAL LICENSE
FL038802500Medicaid
FL1578538542OtherNPI FOR DR. GOMEZ INDIV.
FL038802500Medicaid
FLME0035412OtherMEDICAL LICENSE