Provider Demographics
NPI:1083680227
Name:GOMEZ-VAZQUEZ, JOSE (MD)
Entity Type:Individual
Prefix:
First Name:JOSE
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 1:7210 MCPHERSON
Mailing Address - Street 2:STE 115
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041
Mailing Address - Country:US
Mailing Address - Phone:956-725-6872
Mailing Address - Fax:956-725-9412
Practice Address - Street 1:7210 MCPHERSON
Practice Address - Street 2:STE 115
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041
Practice Address - Country:US
Practice Address - Phone:956-725-6872
Practice Address - Fax:956-725-9412
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-27
Last Update Date:2012-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH0390207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8AH954OtherBCBS
TX050009507OtherRAILROAD MEDICARE
TX089803301Medicaid
TX089803304Medicaid
TX00D79AOtherBLUE CROSS BLUE SHIELD
TX089803303Medicaid
TXTXB127826Medicare PIN
TX050009507OtherRAILROAD MEDICARE
E77556Medicare UPIN