Provider Demographics
NPI:1578538542
Name:GOMEZ, EDUARDO G (MD)
Entity Type:Individual
Prefix:DR
First Name:EDUARDO
Middle Name:G
Last Name:GOMEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:EDUARDO
Other - Middle Name:G
Other - Last Name:GOMEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD PA
Mailing Address - Street 1:1840 W 49TH ST
Mailing Address - Street 2:SUITE 607
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-2942
Mailing Address - Country:US
Mailing Address - Phone:305-556-7416
Mailing Address - Fax:305-824-0879
Practice Address - Street 1:1840 W 49TH ST
Practice Address - Street 2:SUITE 607
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-2942
Practice Address - Country:US
Practice Address - Phone:305-556-7416
Practice Address - Fax:305-824-0879
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-22
Last Update Date:2013-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0035412207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL038802500Medicaid
E81526Medicare UPIN
FL038802500Medicaid