Provider Demographics
NPI:1164750907
Name:JULIAN GOMEZ III, M.D. PA
Entity Type:Organization
Organization Name:JULIAN GOMEZ III, M.D. PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GOMEZ
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:956-630-2786
Mailing Address - Street 1:1801 S 5TH ST
Mailing Address - Street 2:SUITE 124
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78503-2927
Mailing Address - Country:US
Mailing Address - Phone:956-630-2786
Mailing Address - Fax:956-630-4329
Practice Address - Street 1:1801 S 5TH ST
Practice Address - Street 2:SUITE 124
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78503-2927
Practice Address - Country:US
Practice Address - Phone:956-630-2786
Practice Address - Fax:956-630-4329
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-04
Last Update Date:2009-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX110135402Medicaid
TXC16226Medicare UPIN
TX00JJ75Medicare PIN