Provider Demographics
NPI:1326023862
Name:GOMEZ, VICTOR M (MD)
Entity Type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:M
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 1:7777 FOREST LN STE B222
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-2528
Mailing Address - Country:US
Mailing Address - Phone:972-566-7007
Mailing Address - Fax:972-566-7013
Practice Address - Street 1:7777 FOREST LN STE B222
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-2528
Practice Address - Country:US
Practice Address - Phone:972-566-7007
Practice Address - Fax:972-566-7013
Is Sole Proprietor?:No
Enumeration Date:2005-12-07
Last Update Date:2014-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM4794207RP1001X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000914306CMedicaid
TX613521OtherMEDICARE
GA000914306CMedicaid
TXTXB141714Medicare PIN
TXTXB107764Medicare PIN
TX613521OtherMEDICARE