Provider Demographics
NPI:1235556085
Name:GOMEZ, MARCO ANTONIO (PA)
Entity Type:Individual
Prefix:MR
First Name:MARCO
Middle Name:ANTONIO
Last Name:GOMEZ
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 S. BRYAN RD. STE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-6208
Mailing Address - Country:US
Mailing Address - Phone:956-581-7481
Mailing Address - Fax:956-580-2657
Practice Address - Street 1:210 S. BRYAN RD. STE
Practice Address - Street 2:SUITE 1
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-6208
Practice Address - Country:US
Practice Address - Phone:956-581-7481
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-18
Last Update Date:2014-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA02281363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant