Provider Demographics
NPI:1215181318
Name:MARIA R GOMEZ MD PA
Entity Type:Organization
Organization Name:MARIA R GOMEZ MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:ROSARIO
Authorized Official - Last Name:GOMEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-873-2663
Mailing Address - Street 1:302 N DALE MABRY HWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609-1249
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:33609-1249
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:2008-11-17
Last Update Date:2014-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL045372200Medicaid
FL79920OtherBCBS
FL045372200Medicaid
FLE14703Medicare UPIN