Provider Demographics
NPI:1639885650
Name:GAMEZ, MARCO ANTONIO
Entity Type:Individual
Prefix:
First Name:MARCO
Middle Name:ANTONIO
Last Name:GAMEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4700 MILLENIA BLVD STE 650
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32839-6013
Mailing Address - Country:US
Mailing Address - Phone:407-533-6836
Mailing Address - Fax:407-232-9316
Practice Address - Street 1:1910 JOHN RALSTON RD STE 200
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77013-5531
Practice Address - Country:US
Practice Address - Phone:713-673-9000
Practice Address - Fax:855-895-8185
Is Sole Proprietor?:No
Enumeration Date:2023-01-24
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX1102075363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily