Provider Demographics
NPI:1689635633
Name:GOMEZ, PASTOR (MD)
Entity Type:Individual
Prefix:DR
First Name:PASTOR
Middle Name:
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 1:9276 WATOLLA DR
Mailing Address - Street 2:
Mailing Address - City:THONOTOSASSA
Mailing Address - State:FL
Mailing Address - Zip Code:33592-3130
Mailing Address - Country:US
Mailing Address - Phone:580-277-5544
Mailing Address - Fax:813-392-1895
Practice Address - Street 1:7444 PALM RIVER RD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33619-4128
Practice Address - Country:US
Practice Address - Phone:813-392-1894
Practice Address - Fax:813-392-1895
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2022-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12082208000000X
MI4301088842208000000X
FLME153892208000000X
FLACN1038208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200207740AMedicaid
OK8HK321Medicare UPIN