Provider Demographics
NPI:1407823248
Name:GOMEZ-MARTINEZ, MARISSA (MD)
Entity Type:Individual
Prefix:
First Name:MARISSA
Middle Name:
Last Name:GOMEZ-MARTINEZ
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:PO BOX 749
Mailing Address - Street 2:
Mailing Address - City:PHARR
Mailing Address - State:TX
Mailing Address - Zip Code:78577-1614
Mailing Address - Country:US
Mailing Address - Phone:956-362-2171
Mailing Address - Fax:956-378-9376
Practice Address - Street 1:1601 E SPRAGUE ST
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78542-5260
Practice Address - Country:US
Practice Address - Phone:956-378-9290
Practice Address - Fax:956-378-9376
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2017-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM0415207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX212749003Medicaid
TX212749003Medicaid
TX613536/GROUP PTANMedicare PIN
TX8L18613Medicare PIN
TX8D5334Medicare ID - Type Unspecified