Provider Demographics
NPI:1568440634
Name:GOMEZ, ADRIENNE R (MD)
Entity Type:Individual
Prefix:DR
First Name:ADRIENNE
Middle Name:R
Last Name:GOMEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5403 REDBERRY CT
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46254-9402
Mailing Address - Country:US
Mailing Address - Phone:317-280-1922
Mailing Address - Fax:
Practice Address - Street 1:11495 N PENNSYLVANIA ST
Practice Address - Street 2:SUITE 100
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-6943
Practice Address - Country:US
Practice Address - Phone:317-705-1400
Practice Address - Fax:317-705-1404
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01055742A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN233560Medicare ID - Type Unspecified
INH92550Medicare UPIN