Provider Demographics
NPI:1093804189
Name:GOMEZ DELGADO DE LA FLOR, MARIO (MD)
Entity Type:Individual
Prefix:
First Name:MARIO
Middle Name:
Last Name:GOMEZ DELGADO DE LA FLOR
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 1:1604 E 8TH ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:WESLACO
Mailing Address - State:TX
Mailing Address - Zip Code:78596-5587
Mailing Address - Country:US
Mailing Address - Phone:956-447-5557
Mailing Address - Fax:956-447-5747
Practice Address - Street 1:1604 E 8TH ST STE A
Practice Address - Street 2:
Practice Address - City:WESLACO
Practice Address - State:TX
Practice Address - Zip Code:78596-5587
Practice Address - Country:US
Practice Address - Phone:956-447-5557
Practice Address - Fax:956-447-5747
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN2090207RC0200X, 207RP1001X, 207RP1001X
SCLL28887207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXN2090OtherTEXAS LICENSE
TX211302901Medicaid
TXN2090OtherTEXAS LICENSE