Provider Demographics
NPI:1346393865
Name:GOMEZ CARRERA, RICARDO M (MD)
Entity Type:Individual
Prefix:DR
First Name:RICARDO
Middle Name:M
Last Name:GOMEZ CARRERA
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:PO BOX 6968
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00960
Mailing Address - Country:US
Mailing Address - Phone:787-717-5272
Mailing Address - Fax:787-744-0567
Practice Address - Street 1:PROFESSIONAL CENTER
Practice Address - Street 2:C/ MUNOZ RIVERA #2 STE 302
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-444-2727
Practice Address - Fax:787-744-0567
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2014-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13469207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRI42418Medicare UPIN
PR2-3433Medicare ID - Type Unspecified
PRFC623AMedicare Oscar/Certification