Provider Demographics
NPI:1518927961
Name:GOMEZ, RICHARD RAUL (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:RAUL
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 1:3417 GASTON AVE STE 630
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75246-2030
Mailing Address - Country:US
Mailing Address - Phone:785-845-8961
Mailing Address - Fax:
Practice Address - Street 1:3417 GASTON AVE STE 630
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-2030
Practice Address - Country:US
Practice Address - Phone:469-800-8900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2020-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0427951207ZP0102X
TXK4068207ZP0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory Medicine
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS054662OtherBCBS
KS054662Medicare PIN
KS054662OtherBCBS