Provider Demographics
NPI:1144384611
Name:GOMEZ CORDERO, RODRIGO (MD)
Entity Type:Individual
Prefix:DR
First Name:RODRIGO
Middle Name:
Last Name:GOMEZ CORDERO
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 1:1112 VERGES AVE
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:NE
Mailing Address - Zip Code:68701
Mailing Address - Country:US
Mailing Address - Phone:402-379-8717
Mailing Address - Fax:402-379-0447
Practice Address - Street 1:1112 VERGES AVE
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:NE
Practice Address - Zip Code:68701
Practice Address - Country:US
Practice Address - Phone:402-379-8717
Practice Address - Fax:402-379-0447
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2017-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE15892208D00000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47080766801Medicaid
06484OtherBLUE CROSS BLUE SHIELD NE
2407OtherMIDLANS CHOICE
06484OtherBLUE CROSS BLUE SHIELD NE
NE47080766801Medicaid