Provider Demographics
NPI:1689693699
Name:GOMES, DANIEL ROY (DPM)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:ROY
Last Name:GOMES
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
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Mailing Address - Street 1:15 HIDDEN OAK CT
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94506-2022
Mailing Address - Country:US
Mailing Address - Phone:925-484-1395
Mailing Address - Fax:925-924-0969
Practice Address - Street 1:1800 MOWRY AVE
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-1712
Practice Address - Country:US
Practice Address - Phone:510-794-6699
Practice Address - Fax:510-794-6637
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2013-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE1728213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE1728OtherSTATE LICENSE NUMBER
CAE1728OtherSTATE LICENSE NUMBER
CAE1728OtherSTATE LICENSE NUMBER
CAT11042Medicare UPIN