Provider Demographics
NPI:1093059818
Name:MIGUEL A GOMEZ MD PA
Entity Type:Organization
Organization Name:MIGUEL A GOMEZ MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MIGUEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:GOMEZ
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:713-932-6251
Mailing Address - Street 1:18400 KATY FWY
Mailing Address - Street 2:STE 480
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77094-1286
Mailing Address - Country:US
Mailing Address - Phone:832-260-0500
Mailing Address - Fax:832-260-0488
Practice Address - Street 1:18400 KATY FWY
Practice Address - Street 2:STE 480
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77094-1286
Practice Address - Country:US
Practice Address - Phone:832-260-0500
Practice Address - Fax:832-260-0488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-16
Last Update Date:2013-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ20312086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXG78105Medicare UPIN