Provider Demographics
NPI:1386685055
Name:GOMEZ, ERNESTO MORALES (MD)
Entity Type:Individual
Prefix:DR
First Name:ERNESTO
Middle Name:MORALES
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 748860
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-5001
Mailing Address - Country:US
Mailing Address - Phone:480-897-8000
Mailing Address - Fax:480-830-3690
Practice Address - Street 1:7233 E BASELINE RD STE 105
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85209-5001
Practice Address - Country:US
Practice Address - Phone:480-897-8000
Practice Address - Fax:480-830-3690
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ12743207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1Z0552OtherHEALTH NET
AZAZ0038280OtherBC/BS
AZ251413OtherAHCCCS
AZ251413OtherAHCCCS
AZZWCHVZMedicare ID - Type Unspecified