Provider Demographics
NPI:1609217843
Name:BUGANO DINIZ GOMES, DIOGO (MD)
Entity Type:Individual
Prefix:
First Name:DIOGO
Middle Name:
Last Name:BUGANO DINIZ GOMES
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 1:2900 N BRAESWOOD BLVD
Mailing Address - Street 2:SUITE 2203
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77025-2329
Mailing Address - Country:US
Mailing Address - Phone:832-566-8413
Mailing Address - Fax:
Practice Address - Street 1:2900 N BRAESWOOD BLVD
Practice Address - Street 2:SUITE 2203
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77025-2329
Practice Address - Country:US
Practice Address - Phone:832-566-8413
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-16
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZ139559207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine