Provider Demographics
NPI:1609972751
Name:GOMEZ, RAFAEL T (MD)
Entity Type:Individual
Prefix:DR
First Name:RAFAEL
Middle Name:T
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 1:1200 NE 55TH BOULEVARD
Mailing Address - Street 2:NORTH FLORIDA EDUCATION & TREATMENT CENTER
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32641-2759
Mailing Address - Country:US
Mailing Address - Phone:352-375-8484
Mailing Address - Fax:352-264-8304
Practice Address - Street 1:1200 NE 55TH BOULEVARD
Practice Address - Street 2:NFETC
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32641-2759
Practice Address - Country:US
Practice Address - Phone:352-375-8484
Practice Address - Fax:352-264-8304
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2009-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME250882084P0800X
FL250882084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL056477000Medicaid
FLD85997Medicare UPIN
D85997Medicare UPIN
FL53476XMedicare ID - Type Unspecified
FL056477000Medicaid