Provider Demographics
NPI:1053470070
Name:GOMEZ-VAZQUEZ, JORGE (MD)
Entity Type:Individual
Prefix:DR
First Name:JORGE
Middle Name:
Last Name:GOMEZ-VAZQUEZ
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 1:7215 MCPHERSON RD
Mailing Address - Street 2:SUITE # 115
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041-6554
Mailing Address - Country:US
Mailing Address - Phone:956-608-4500
Mailing Address - Fax:956-608-4501
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
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2017-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ-4160207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX118617303Medicaid
TXJ-4160OtherTEXAS PHYSICAN PERMIT
TXN0087586OtherDPS REGISTRATION NUMBER
TX118617303Medicaid
TXF90871Medicare UPIN