Provider Demographics
NPI:1376507673
Name:GOMEZ, OMAR A (MD)
Entity Type:Individual
Prefix:DR
First Name:OMAR
Middle Name:A
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 1:230 N RUFE SNOW DR
Mailing Address - Street 2:
Mailing Address - City:KELLER
Mailing Address - State:TX
Mailing Address - Zip Code:76248-4226
Mailing Address - Country:US
Mailing Address - Phone:817-337-5503
Mailing Address - Fax:817-337-0110
Practice Address - Street 1:230 N RUFE SNOW DR
Practice Address - Street 2:
Practice Address - City:KELLER
Practice Address - State:TX
Practice Address - Zip Code:76248-4226
Practice Address - Country:US
Practice Address - Phone:817-337-5503
Practice Address - Fax:817-337-0110
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2009-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ8553208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
1164541967OtherFORT WORTH GROUP NPI
TX118706405Medicaid
1710006598OtherKELLER GROUP NPI
TX0046KVOtherBCBS GROUP
TX8K6660OtherBCBS
TXG46113Medicare UPIN