Provider Demographics
NPI:1184664492
Name:GOMEZ, PATRICK (MD)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:
Last Name:GOMEZ
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 1:5959 GATEWAY WEST
Mailing Address - Street 2:STE 160
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79925-3315
Mailing Address - Country:US
Mailing Address - Phone:915-779-1716
Mailing Address - Fax:915-771-6496
Practice Address - Street 1:5959 GATEWAY WEST
Practice Address - Street 2:STE 160
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79925-3315
Practice Address - Country:US
Practice Address - Phone:915-779-5866
Practice Address - Fax:915-771-6558
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2011-09-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXJ2580207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX118690001Medicaid
TX118690001Medicaid
F33439Medicare UPIN