Provider Demographics
NPI:1376595256
Name:GOMEZ, JAIME S (MD)
Entity Type:Individual
Prefix:DR
First Name:JAIME
Middle Name:S
Last Name:GOMEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:5700 N EXPRESSWAY 77/83 STE 303
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78526-4355
Mailing Address - Country:US
Mailing Address - Phone:956-504-7121
Mailing Address - Fax:956-504-7246
Practice Address - Street 1:5700 N EXPRESSWAY 77/83 STE 303
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78526-4355
Practice Address - Country:US
Practice Address - Phone:956-504-7121
Practice Address - Fax:956-504-7246
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2019-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL3663207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX214000601Medicaid
TX214000601Medicaid