Provider Demographics
NPI:1184860223
Name:FRANCISCO M GOMEZ MD PA
Entity Type:Organization
Organization Name:FRANCISCO M GOMEZ MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FRANCISCO
Authorized Official - Middle Name:MANUEL
Authorized Official - Last Name:GOMEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-873-2663
Mailing Address - Street 1:503 S MACDILL AVENUE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609-3000
Mailing Address - Country:US
Mailing Address - Phone:813-873-2663
Mailing Address - Fax:813-873-7001
Practice Address - Street 1:302 N DALE MABRY HWY
Practice Address - Street 2:SUITE 200
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-1239
Practice Address - Country:US
Practice Address - Phone:813-873-2663
Practice Address - Fax:813-873-7001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-19
Last Update Date:2013-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207X00000X
FLME39173207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL62530OtherBLUE CROSS BLUE SHIELD
FL040304100Medicaid
FL62530Medicare UPIN