Provider Demographics
NPI:1639139926
Name:GOMEZ, MIGUEL A (MD)
Entity Type:Individual
Prefix:
First Name:MIGUEL
Middle Name:A
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 1:902 FROSTWOOD DR
Mailing Address - Street 2:#144
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-2420
Mailing Address - Country:US
Mailing Address - Phone:713-973-7222
Mailing Address - Fax:713-464-6427
Practice Address - Street 1:902 FROSTWOOD DR
Practice Address - Street 2:#144
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024-2420
Practice Address - Country:US
Practice Address - Phone:713-973-7222
Practice Address - Fax:713-464-6427
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ20312086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
G78105Medicare UPIN