Provider Demographics
NPI:1083628192
Name:GOMEZ, HERNAN ANTONIO (MD)
Entity Type:Individual
Prefix:
First Name:HERNAN
Middle Name:ANTONIO
Last Name:GOMEZ
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 1:339 CYPRESS PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34759-3315
Mailing Address - Country:US
Mailing Address - Phone:727-407-3433
Mailing Address - Fax:407-343-8888
Practice Address - Street 1:339 CYPRESS PKWY STE 100
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34759-3315
Practice Address - Country:US
Practice Address - Phone:407-343-3333
Practice Address - Fax:407-343-8888
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME94311207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL276146700Medicaid
FL276146700Medicaid
FLAA419ZMedicare PIN