Provider Demographics
NPI:1215218680
Name:NARCISO L GOMEZ MD
Entity Type:Organization
Organization Name:NARCISO L GOMEZ MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NARCISO
Authorized Official - Middle Name:L
Authorized Official - Last Name:GOMEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-369-5717
Mailing Address - Street 1:325 S BISCAYNE BLVD
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33131-2306
Mailing Address - Country:US
Mailing Address - Phone:954-369-5717
Mailing Address - Fax:954-827-0717
Practice Address - Street 1:12781 MIRAMAR PKWY
Practice Address - Street 2:SUITE 206
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33027-2908
Practice Address - Country:US
Practice Address - Phone:954-369-5717
Practice Address - Fax:954-827-0717
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-30
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME98664208600000X, 208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal SurgeryGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL280214700Medicaid
AK289ZMedicare PIN