Provider Demographics
NPI:1134327661
Name:GOMEZ, MELISSA MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:MARIE
Last Name:GOMEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 46
Mailing Address - Street 2:
Mailing Address - City:OHKAY OWINGEH
Mailing Address - State:NM
Mailing Address - Zip Code:87566-0046
Mailing Address - Country:US
Mailing Address - Phone:505-484-6443
Mailing Address - Fax:505-484-6441
Practice Address - Street 1:298 NM-74
Practice Address - Street 2:
Practice Address - City:OHKAY OWINGEH
Practice Address - State:NM
Practice Address - Zip Code:87566
Practice Address - Country:US
Practice Address - Phone:505-484-6443
Practice Address - Fax:505-484-6441
Is Sole Proprietor?:No
Enumeration Date:2007-07-05
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBT23410661236207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine