Provider Demographics
NPI:1578912044
Name:GOMEZ, ADAM DANIEL (MD, SA-C)
Entity Type:Individual
Prefix:DR
First Name:ADAM
Middle Name:DANIEL
Last Name:GOMEZ
Suffix:
Gender:M
Credentials:MD, SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4413 WISTERIA AVE
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-5589
Mailing Address - Country:US
Mailing Address - Phone:956-227-1974
Mailing Address - Fax:
Practice Address - Street 1:4413 WISTERIA AVE
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-5589
Practice Address - Country:US
Practice Address - Phone:956-227-1974
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-06
Last Update Date:2017-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16-378246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX16-378OtherAMERICAN BOARD OF SURGICAL ASSISTANTS