Provider Demographics
NPI:1346460888
Name:GOMEZ, MIRIAM (MD)
Entity Type:Individual
Prefix:DR
First Name:MIRIAM
Middle Name:
Last Name:GOMEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:908 S PARSONS AVE STE A
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-6045
Mailing Address - Country:US
Mailing Address - Phone:813-681-3400
Mailing Address - Fax:813-681-1950
Practice Address - Street 1:908 S PARSONS AVE STE A
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-6045
Practice Address - Country:US
Practice Address - Phone:813-681-3400
Practice Address - Fax:813-681-1950
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME98072207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL593400761OtherHUMANA MEDICARE PROVIDER NUMBER
FL94434OtherBCBS PROVIDER NUMBER
FL2021896OtherCIGNA PROVIDER NUMBER
FL593400761COtherHUMANA COMMERCIAL PROVIDER NUMBER
FL2021896OtherCIGNA PROVIDER NUMBER
FL94434OtherBCBS PROVIDER NUMBER