Provider Demographics
NPI:1326093519
Name:GOMEZ, JUAN PABLO (MD,)
Entity Type:Individual
Prefix:DR
First Name:JUAN
Middle Name:PABLO
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 1:1200 E SAVANNAH AVE
Mailing Address - Street 2:STE 12
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78503
Mailing Address - Country:US
Mailing Address - Phone:956-688-6300
Mailing Address - Fax:956-688-6303
Practice Address - Street 1:1200 E SAVANNAH AVE
Practice Address - Street 2:STE 12
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78503
Practice Address - Country:US
Practice Address - Phone:956-688-6300
Practice Address - Fax:956-688-6303
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2008-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL8350207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8BM781OtherBLUECROSS BLUESHIELD OF TEXAS
TX165404804Medicaid
TX8BM781OtherBLUECROSS BLUESHIELD OF TEXAS