Provider Demographics
NPI:1336119429
Name:GOMEZ, JOSE (MD)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:
Last Name:GOMEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8987
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00732-8987
Mailing Address - Country:US
Mailing Address - Phone:787-843-8510
Mailing Address - Fax:787-840-7794
Practice Address - Street 1:2275 PONCE BY PASS
Practice Address - Street 2:CARIBBEAN MEDICAL CENTRE SUITE 103
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-1380
Practice Address - Country:US
Practice Address - Phone:787-843-8510
Practice Address - Fax:787-840-7794
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR10214207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRG00410Medicare UPIN
PR0084619Medicare ID - Type Unspecified