Provider Demographics
NPI:1659461515
Name:OMAR A GOMEZ MD PA
Entity Type:Organization
Organization Name:OMAR A GOMEZ MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:OMAR
Authorized Official - Middle Name:A
Authorized Official - Last Name:GOMEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-475-3031
Mailing Address - Street 1:524 S CAGE BLVD
Mailing Address - Street 2:SUITE F
Mailing Address - City:PHARR
Mailing Address - State:TX
Mailing Address - Zip Code:78577-5448
Mailing Address - Country:US
Mailing Address - Phone:956-475-3031
Mailing Address - Fax:956-475-3680
Practice Address - Street 1:524 S CAGE BLVD
Practice Address - Street 2:SUITE F
Practice Address - City:PHARR
Practice Address - State:TX
Practice Address - Zip Code:78577-5448
Practice Address - Country:US
Practice Address - Phone:956-475-3031
Practice Address - Fax:956-475-3680
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL2283207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX154121101Medicaid
TX00250UMedicare PIN