Provider Demographics
NPI:1164541967
Name:OMAR A. GOMEZ, M.D.,P.A.
Entity Type:Organization
Organization Name:OMAR A. GOMEZ, M.D.,P.A.
Other - Org Name:KID CARE PEDIATRICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:OMAR
Authorized Official - Middle Name:A
Authorized Official - Last Name:GOMEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-337-5503
Mailing Address - Street 1:230 N RUFE SNOW DR
Mailing Address - Street 2:
Mailing Address - City:KELLER
Mailing Address - State:TX
Mailing Address - Zip Code:76248-4226
Mailing Address - Country:US
Mailing Address - Phone:817-337-5503
Mailing Address - Fax:817-337-0110
Practice Address - Street 1:6618 FOSSIL BLUFF DR
Practice Address - Street 2:SUITE 116
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76137-7533
Practice Address - Country:US
Practice Address - Phone:817-847-6420
Practice Address - Fax:817-847-6412
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2007-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty